Copyright
©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Jan 16, 2020; 12(1): 17-22
Published online Jan 16, 2020. doi: 10.4253/wjge.v12.i1.17
Efficacy of mucosa-submucosa clip closure method after gastric endoscopic submucosal dissection
Satoshi Kinoshita, Toshihiro Nishizawa, Ai Fujimoto, Hideki Mori, Yoshihiro Nakazato, Masahiro Kikuchi, Toshio Uraoka
Satoshi Kinoshita, Toshihiro Nishizawa, Ai Fujimoto, Hideki Mori, Yoshihiro Nakazato, Masahiro Kikuchi, Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo 152-8902, Japan
Satoshi Kinoshita, Toshihiro Nishizawa, Ai Fujimoto, Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo 160-8582, Japan
Toshihiro Nishizawa, Department of Gastroenterology and Hepatology, International University of Health and Welfare Mita Hospital, Tokyo 108-8329, Japan
Toshio Uraoka, Department of Internal Medicine, Division of Gastroenterology and Hepatology, Gunma University, Maebashi 371-8511, Japan
Author contributions: All authors helped to perform the research; Kinoshita S and Nishizawa T contributed to manuscript writing and data analysis; Kinoshita S, Nishizawa T, Fujimoto A and Mori H performed the procedures; Nakazato Y and Kikuchi M recruited the patients; Uraoka T developed the mucosa-submucosa clip closure method.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Tokyo Medical Center.
Informed consent statement: Informed consent was obtained from all patients.
Conflict-of-interest statement: All authors declare no conflicts-of-interest related to this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Toshihiro Nishizawa, MD, PhD, Doctor, Department of Gastroenterology and Hepatology, International University of Health and Welfare Mita Hospital, Mita 1-4-3 Minato-ku, Tokyo 108-8329, Japan. nisizawa@kf7.so-net.jp
Received: May 15, 2019
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
BACKGROUND
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.
AIM
To elucidate the efficacy of the endoscopic mucosa-submucosa clip closure method after gastric endoscopic submucosal dissection (ESD).
METHODS
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.
RESULTS
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%.
CONCLUSION
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.
