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Endoscopic slip-knot clip suturing method: prospective pilot study (with video).

Toshihiro Nishizawa1, Yasutoshi Ochiai2, Toshio Uraoka3

  • 1Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.

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Summary

This study shows a new slip-knot clip suturing method effectively closes large endoscopic mucosal defects. This technique offers a high success rate for single-channel endoscope procedures.

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Area of Science:

  • Gastroenterology
  • Endoscopic Surgery
  • Medical Device Innovation

Background:

  • Endoscopic submucosal dissection (ESD) for gastrointestinal tumors can result in large mucosal defects.
  • Closing these defects is crucial for patient recovery and preventing complications.
  • Existing methods may be limited with single-channel endoscopes.

Purpose of the Study:

  • To develop and evaluate a novel slip-knot clip suturing method for closing mucosal defects after ESD.
  • To assess the feasibility and efficacy of this technique using a single-channel endoscope.

Main Methods:

  • A slip-knot loop and clip system was designed for passage through a 3.2 mm instrument channel.
  • The method involves anchoring the loop with clips and tightening it by pulling the string.
  • Ten patients with colorectal and duodenal tumors underwent the procedure.

Main Results:

  • The slip-knot clip suturing method achieved a 90% success rate (9/10 patients).
  • The mean size of resected specimens was 34.4 mm.
  • Mean procedure time was 18.2 minutes; initial string friction was overcome by using a wet string.

Conclusions:

  • The slip-knot clip suturing method is a feasible and effective technique for complete closure of large mucosal defects.
  • This method expands the capabilities of single-channel endoscopes for complex endoscopic procedures.