Yoshida Akira, Kurumi Hiroki, Ikebuchi Yuichiro, Kawaguchi Koichiro, Yashima Kazuo, Kamitani Yu, Yasui Sho, Nakada Yusuke, Kanda Tsutomu, Takata Tomoaki, Isomoto Hajime
Division of Gastroenterology and Nephrology, Faculty of Medicine, Tottori University, Tottori 683-8504, Japan.
J Clin Med. 2021 Jul 23;10(15):3260. doi: 10.3390/jcm10153260.
Endoscopic submucosal dissection (ESD) and resection of stomach and colon tumors have become common. However, mucosal defects resulting from ESD may cause delayed bleeding and perforation. To prevent adverse events, we developed a new clip closure technique, namely, the loop and open-close clip closure method (LOCCM), and aimed to examine its efficacy after ESD for stomach and colon tumors. The LOCCM uses loop and open-close clips. Here, the open-close clip was used to grasp the loop to bring it to the edge of the post-ESD mucosal defect. Another clip with a loop was then inserted into the opposite edge and clipped to the contralateral mucosa to pull both edges together. Once apposed, additional clips facilitated complete closure. The LOCCM was performed in 19 patients after ESD at Tottori University between October 2020 and March 2021. The outcomes retrospectively analyzed were the LOCCM success and adverse event rates. The complete closure rate using LOCCM was 89.5% and none of the patients had post-ESD bleeding or perforation. The results show that LOCCM is an effective and safe closure technique for mucosal defects after stomach and colon ESD to prevent bleeding and perforation.
内镜黏膜下剥离术(ESD)以及胃和结肠肿瘤切除术已变得很常见。然而,ESD导致的黏膜缺损可能会引起延迟性出血和穿孔。为预防不良事件,我们开发了一种新的夹子闭合技术,即环行开合夹子闭合法(LOCCM),并旨在研究其用于胃和结肠肿瘤ESD术后的疗效。LOCCM使用环行夹子和开合夹子。在此,开合夹子用于抓住环行夹子,将其拉至ESD术后黏膜缺损边缘。然后将另一个带环行的夹子插入相对边缘,并夹在对侧黏膜上,将两边拉拢。一旦对合,额外的夹子有助于实现完全闭合。2020年10月至2021年3月期间,鸟取大学对19例患者在ESD术后实施了LOCCM。回顾性分析的结果是LOCCM的成功率和不良事件发生率。使用LOCCM的完全闭合率为89.5%,且无一例患者发生ESD术后出血或穿孔。结果表明,LOCCM是一种用于胃和结肠ESD术后黏膜缺损的有效且安全的闭合技术,可预防出血和穿孔。