New devices and techniques for endoscopic closure of gastrointestinal perforations

Figure 1 Over the scope clip system and clips applied to make a successful closure. A: When endoscopic submucosal dissection (ESD) was performed for a lesion located in gastric antrum, a large perforation occurred, which was about 30 mm × 15 mm; B: The omentum majus could be seen through the perforation; C: It was difficult to make complete closure using only endoclips, and the over the scope clip (OTSC) system was applied to close the perforation. However, only partial closure was achieved because the perforation was too large; D: Eight endoclips were then used to make a complete closure.