2022 Volume 64 Issue 12 Pages 2516-2523
Various new methods have been devised for closing mucosal defects after ESD to reduce postoperative adverse events. However, no method has been developed for complete closure of the thick mucosa and muscular layer of the stomach without dead space between the mucosa and muscular layer. Here, we report a new method for defect closure, the reopenable clip over the line method (ROLM); this new method uses a nylon line and a hole in the tooth of a reopenable clip. This method reduces dead space and closes defects by grasping the clip at the edge of the defect and the nearby muscle layer and pulling the line by hand. Defect closure can be achieved by repeatedly placing a clip on the edge of the mucosal defect on one side and the muscle layer and then placing the next clip on the edge of the mucosal defect on the contralateral side and the muscle layer. ROLM is a simple method because it eliminates the need to clip both sides of the mucosal defect with a single clip. In addition, ROLM can be performed for post-ESD mucosal defects in the colon and duodenum, where endoscopic maneuverability is poor.