Post written by Kohei Ono, MD, from NTT Medical Center Tokyo, Tokyo, Japan.

In this video, we present a simple, easy, and robust method for closing mucosal defects after colorectal endoscopic submucosal dissection using reopenable clips, nylon thread, and an endoloop in a short period.

Various methods for suturing mucosal defects after endoscopic treatment have been reported, but many require special endoscopes and attachments, and the procedures tend to be complicated. The advantage of this method is that it can be performed quickly and easily as 1 series of consecutive procedures using commercially available instruments, and its greatest feature is that the entire defect is tightened and fixed by the endoloop at the end of the procedure. This tightening increases the strength and robustness of the suture.

With this method, stronger suturing can be achieved. This approach has the potential to be applied not only to mucosal defects but also any situation requiring suturing.

Zig-zag CLiPS for large mucosal defect. A, The first clip with thread is placed on the edge of the distal side. B, A second clip is placed opposite the first clip. C, The third clip is placed adjacent and proximal to the first clip. D, Additional clips are arrayed in a zigzag pattern to cover the entire mucosal defect. E and F, By pulling the thread, the defect is pulled toward the scope and contracted. G, A plastic detachable snare is delivered through the thread, and the thread is secured. H, The large defect is closed completely in 1 session.

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