'Hold-and-drag' closure technique using repositionable clips for large mucosal defects after colonic endoscopic submucosal dissection

Background and study Aims: To prevent complications after colonic endoscopic submucosal dissection (ESD), we developed a new closure technique using repositionable clips. Patients and methods: The closure of post-ESD mucosal defects was attempted in 19 cases. Mucosal defects were linearly closed by holding and dragging the anal mucosal edge towards the oral mucosal edge using repositionable clips. Standard hemoclips were additionally placed to complete the closure. We retrospectively assessed the feasibility of this technique. Results: Defect closure was successfully completed in 18 cases (94.7 %). The mean defect size and the procedural time were 40.2 ± 12.0 mm (range, 24 – 71 mm) and 10.7 ± 7.2 min (range, 4.0 – 29.9 min), respectively. The mean number of repositionable clips and standard clips required for closure was 1.6 ± 0.8 (range, 1 – 3) and 7.3 ± 3.7 (range, 3 – 16), respectively. No adverse events occurred during procedures and thereafter (95 % confidence interval, 0 – 17.6 %). Conclusions: The new closure technique for large mucosal defects after colonic ESD using repositionable clips was feasible and appeared effective for preventing subsequent adverse events.