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Efficacy of Clip with Line Pulley Securing (CLiPS) for mucosal defect closure after gastric submucosal dissection (ESD)
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Eiji Sakai1,
Yohei Minato2,
Hideyuki Chiba3 |
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1Division of Gastroenterology, Yokohama Sakae Kyosai Hospital, 2Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, 3Department of Gastroenterology, Omori Red Cross Hospital |
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Introduction: Defect closure has been reported to potentially reduce the risk of delayed bleeding, but complete suturing of large mucosal defects is difficult and time-consuming. In this study, we prospectively evaluated the efficacy of a plastic detachable snare and clip-based suturing technique, named CLiPS, for the prevention of delayed bleeding after gastric ESD. Method: Between October 2023 and March 2024, we enrolled 50 consecutive patients who underwent gastric ESD. Subsequent to resection of the tumor, mucosal defects were sutured using CLiPS. Two days after the initial treatment, endoscopic examination was performed to ensure that the defect closure was maintained. The primary outcomes were the rate of successful defect closure and delayed bleeding. Results: All lesions were successfully resected en-bloc in a mean procedure time of 32.9minutes. The mean diameter of resected specimen was 33.8mm. All the mucosal defect (50/50) was successfully closed using 1.0 (range 1-5) median number of CLiPS. The defect closure time was 17.8minutes. To note, no delayed bleeding occurred, despite 11 (22.0%) patients who taking antithrombotic drugs were included in this study. Complete suture of ulcer floor was maintained in 83.7% (41/49) of cases even 2 days after the initial treatment, which may have contributed to the prevention of delayed bleeding. Conclusion: CLiPS can be a usefull method to completely close mucosal defects and prevent delayed bleeding after gastric ESD.
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Index Term 1: gastric ESD
Index Term 2: defect closure
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