Published online Jan 16, 2020. doi: 10.4253/wjge.v12.i1.17
Peer-review started: May 20, 2019
First decision: August 2, 2019
Revised: August 30, 2019
Accepted: November 6, 2019
Article in press: November 6, 2019
Published online: January 16, 2020
Processing time: 216 Days and 9.9 Hours
We recently developed a new endoscopic closure technique using only conventional endo-clips for colorectal lesions. Little is known about the feasibility of the endoscopic mucosa-submucosa clip closure method for gastric lesions.
To elucidate the efficacy of the endoscopic mucosa-submucosa clip closure method after gastric endoscopic submucosal dissection (ESD).
Twenty-two patients who underwent gastric ESD and mucosa-submucosa clip closure were included in this study. In this method, endo-clips are placed at the edges of a mucosal defect. Additional endo-clips are then applied in the same way to facilitate reduction of the defect size. Additional endo-clips are applied to both sides of the mucosal defect. Complete closure can be achieved. We have also developed a “location score” and “closure difficulty index” for assessment purposes.
Complete closure was achieved in 68.2% of the patients (15/22). The location score in the failure group was significantly larger than that in the complete closure group (P = 0.023). The closure difficulty index in the failure group was significantly higher than that in the complete closure group (P = 0.007). When the cutoff value of the closure difficulty index was set at 99, the high closure difficulty index predicted failure with a sensitivity of 57.1%, specificity of 100%, and accuracy of 86.3%.
The endoscopic mucosa-submucosa clip closure method was unreliable after gastric ESD, especially in cases with a high closure difficulty index.
Core tip: The endoscopic mucosa-submucosa clip closure method is a simple closure method using only conventional clips. The success rate of the endoscopic mucosa-submucosa clip closure method was 68.2% (15/22) after gastric endoscopic submucosal dissection. The location and size of a mucosal defect were considered to be the main factors underlying difficulty in closure. Defects were relatively easy to close in the greater curvature of the upper or middle third stomach, because the gastric wall was relatively thin and soft and a front view approach could be taken.