CLOSURE OF MUCOSAL DEFECTS AFTER ESD USING THE CLIP WITH LINE PULLEY SECURING METHOD(WITH A VIDEO)

Abstract

Recently, various techniques for mucosal defect closure after ESD have been reported, including clip-assisted approximation. However, a standardized approach has yet to be established. Complete closure remains challenging in cases involving large mucosal defects or thick-walled organs, such as the stomach, in which dead space often results in incomplete closure.

Several suture techniques using nylon threads have been developed to achieve more secure closures. We have reported a novel method focusing on reliable tightening and secure fixation of the closure, called the Clip with Line Pulley Securing (CLiPS) method, which combines nylon threads, endoscopic clips, and a detachable snare or similar device to serve as anchors. The edges were firmly approximated by grasping the mucosal defect margins with clips and applying traction to the thread in a pulley-like manner. Fixation with an anchoring device ensured stable closure. This simple and efficient method allows for single-channel operation without repeated endoscope insertion and removal.

We describe detailed procedures and practical tips for performing the CLiPS method effectively.