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New endoscopic suturing method: string clip suturing method
VIDEOGIE Todd H. Baron, MD, G. S. Raju, MD, Editors for VideoGIE
New endoscopic suturing method: string clip suturing method
Figure 1. String clip suturing method. A, Mucosal defect after duodenal endoscopic submucosal dissection (ESD). B, A clip with string is placed at the distal margin of the mucosal defect. C, A second clip is hooked onto the string. D, The second clip anchoring the string is placed at another side of the margin. E, Both sides of the mucosal defect are gathered by pulling the free end of the string, and a third clip is placed. F, A fourth clip is placed. Good string traction can change the field of vision from a side view to a front view. G, Additional endoscopic clips are placed to achieve complete closure. H, The string is cut with an ESD knife. I, Completion. J, Four days after ESD, all clips are still in place.
The endoscopic suture method using an endoloop and several clips requires a double-channel endoscope, which is not always available. We have previously developed a suturing technique with a slip knot string and clips for the single-channel endoscope. This report describes a simpler suturing method using a clip with string. In the string clip suturing method, a clip with string (braided polyester, USP 3-0, Natsume Seisakusho www.giejournal.org
Co Ltd, Bunkyo-ku, Japan) is placed at the distal margin of the mucosal defect, followed by insertion of an additional clip to anchor the string at another side of the margin. The clip and string can be passed through the instrument channel (3.2 mm) of the single-channel endoscope. Both sides of the mucosal defect can be gathered by pulling the free end of the string. Additional endoscopic clips are placed to achieve complete closure. Volume
-,
No.
-
: 2016 GASTROINTESTINAL ENDOSCOPY 1
VideoGIE
Good string traction can change the field of vision from a side view to a front view (Fig. 1; Video 1, available online at www.giejournal.org). This method is simpler than the slip knot clip suturing method and makes it easy to close a large mucosal defect completely by use of a single-channel endoscope.
DISCLOSURE All authors disclosed no financial relationships relevant to this publication.
2 GASTROINTESTINAL ENDOSCOPY Volume
-,
No.
-
: 2016
Naohisa Yahagi, MD, PhD, Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Toshihiro Nishizawa, MD, PhD, Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Teppei Akimoto, MD, Yasutoshi Ochiai, MD, PhD, Osamu Goto, MD, PhD, Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan http://dx.doi.org/10.1016/j.gie.2016.05.054
www.giejournal.org
New endoscopic suturing method: string clip suturing method
Figure 1. String clip suturing method. A, Mucosal defect after duodenal endoscopic submucosal dissection (ESD). B, A clip with string is placed at the distal margin of the mucosal defect. C, A second clip is hooked onto the string. D, The second clip anchoring the string is placed at another side of the margin. E, Both sides of the mucosal defect are gathered by pulling the free end of the string, and a third clip is placed. F, A fourth clip is placed. Good string traction can change the field of vision from a side view to a front view. G, Additional endoscopic clips are placed to achieve complete closure. H, The string is cut with an ESD knife. I, Completion. J, Four days after ESD, all clips are still in place.
The endoscopic suture method using an endoloop and several clips requires a double-channel endoscope, which is not always available. We have previously developed a suturing technique with a slip knot string and clips for the single-channel endoscope. This report describes a simpler suturing method using a clip with string. In the string clip suturing method, a clip with string (braided polyester, USP 3-0, Natsume Seisakusho www.giejournal.org
Co Ltd, Bunkyo-ku, Japan) is placed at the distal margin of the mucosal defect, followed by insertion of an additional clip to anchor the string at another side of the margin. The clip and string can be passed through the instrument channel (3.2 mm) of the single-channel endoscope. Both sides of the mucosal defect can be gathered by pulling the free end of the string. Additional endoscopic clips are placed to achieve complete closure. Volume
-,
No.
-
: 2016 GASTROINTESTINAL ENDOSCOPY 1
VideoGIE
Good string traction can change the field of vision from a side view to a front view (Fig. 1; Video 1, available online at www.giejournal.org). This method is simpler than the slip knot clip suturing method and makes it easy to close a large mucosal defect completely by use of a single-channel endoscope.
DISCLOSURE All authors disclosed no financial relationships relevant to this publication.
2 GASTROINTESTINAL ENDOSCOPY Volume
-,
No.
-
: 2016
Naohisa Yahagi, MD, PhD, Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Toshihiro Nishizawa, MD, PhD, Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Teppei Akimoto, MD, Yasutoshi Ochiai, MD, PhD, Osamu Goto, MD, PhD, Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan http://dx.doi.org/10.1016/j.gie.2016.05.054
www.giejournal.org