Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan.
Department of Endoscopy, Hiroshima City Asa Citizens Hospital, 2-1-1 Kabe Minami, Asakita-ku, Hiroshima, 731-0293, Japan.
Surg Endosc. 2023 Jul;37(7):5719-5725. doi: 10.1007/s00464-023-10146-2. Epub 2023 Jun 5.
Endoscopic clip closure of mucosal defects after colorectal endoscopic submucosal dissection (ESD) reduces the risk of postoperative adverse events, but achieving complete closure for large mucosal defects can be difficult. The aim of this study was to evaluate the effectiveness of the hold-and-drag closure using an SB clip compared with that of the conventional closure for mucosal defects after colorectal ESD.
Eighty-four consecutive colorectal lesions resected by ESD at the Hiroshima Asa Citizens Hospital were registered and randomly allocated to two groups (Group A: SB clip, Group B: EZ clip), and then endoscopic closures were performed. We crossed-over to the SB clip in situations where the initial closure using an EZ clip was unsuccessful in achieving complete closure. Outcomes were compared and analyzed.
Forty-two lesions were randomly assigned to groups A and B. The complete closure rate was significantly higher in group A, especially in resected specimens with a diameter of 30 mm or more. Twelve lesions that failed complete closure in group B were changed to SB clips, and 95% of the whole of group B were successfully closed. There were no significant differences in procedural time, number of clips, and cost of clips between groups A and B.
Compared with the conventional closure, the hold-and-drag closure using an SB clip is a more suitable method for complete closure, especially for large mucosal defects of 30 mm or more. Furthermore, this is a simpler and more economical compared to a zipper closure using EZ clips.
内镜夹闭术可降低结直肠内镜黏膜下剥离术（ESD）后黏膜缺损术后不良事件的风险，但对于较大的黏膜缺损，实现完全闭合较为困难。本研究旨在评估 SB 夹的提拉夹闭与传统夹闭在结直肠 ESD 后黏膜缺损中的有效性。
将在广岛朝仓市民医院接受 ESD 切除的 84 例连续结直肠病变患者进行登记，并随机分为两组（A 组：SB 夹；B 组：EZ 夹），然后进行内镜闭合。在 EZ 夹初始闭合未能实现完全闭合的情况下，我们改用 SB 夹。比较并分析了结局。
42 例病变被随机分配到 A 组和 B 组。A 组的完全闭合率明显更高，尤其是在直径为 30mm 或更大的切除标本中。B 组中有 12 例未能完全闭合的病变改为 SB 夹，B 组的 95%全部成功闭合。A 组和 B 组在手术时间、夹数量和夹费用方面无显著差异。
与传统闭合相比，使用 SB 夹的提拉夹闭术对于完全闭合，特别是对于 30mm 或更大的大黏膜缺损，是一种更合适的方法。此外，与使用 EZ 夹的拉链闭合相比，这种方法更简单、更经济。
