{"title":"十二指肠内镜黏膜下剥离术后，使用锚钉夹闭合大面积黏膜缺损的新型夹闭技术。","authors":"Kohei Shigeta, Noboru Kawata, Hiroyuki Ono","doi":"10.1111/den.14813","DOIUrl":null,"url":null,"abstract":"<p>Duodenal endoscopic submucosal dissection (DESD) has a high incidence of delayed adverse events (AEs).<span><sup>1</sup></span> However, complete mucosal closure (CMC) can reduce the risk of AEs after DESD.<span><sup>2</sup></span> Conventional clip closure is a common technique,<span><sup>1</sup></span> but it poses challenges when used for CMC of large defects after DESD. This case shows a simple closure technique using anchor-pronged clips (MANTIS clip; Boston Scientific, Waltham, MA, USA) for CMC after DESD.</p><p>A 63-year-old man underwent DESD for a 40 mm flat elevated lesion in the descending duodenum (Fig. 1a). During the DESD, an intraprocedural perforation occurred, which was closed using a conventional clip (SureClip; Micro-tech, Nanjing, China). Then en bloc resection was performed on a 47 × 41 mm specimen (Fig. 1b). After resection, mucosal closure was initiated with the anchor-pronged clips for the approximately half circumferential defect (Fig. 2a,b). We grasped the oral edge of the defect using the anchor-pronged clip, allowing us to bring and grasp the opposite side (Video S1). The anchor-pronged clip closed the center of the defect (Fig. 2c), and CMC was achieved in 11 min using seven additional conventional clips (Fig. 2d). The patient was discharged 6 days later without AEs. Pathological examination revealed the lesion was an intramucosal well-differentiated adenocarcinoma with negative resection margins.</p><p>Although there are various techniques for CMC after DESD,<span><sup>1</sup></span> some of these methods require technical skills. Anchor-pronged clip closure is a simple technique that enables the closure of larger defects and overcomes the challenges of conventional clips during the closure procedure, such as tissue slippage when grasping the opposite side.<span><sup>3, 4</sup></span> Furthermore, by applying the previously reported technique of anchor-pronged clip to grasp and suture the muscle layer, it may be possible to reduce suture-induced dead space even in the duodenum.<span><sup>5</sup></span> Therefore, mucosal closure using anchor-pronged clips is a viable option for CMC of large defects after DESD.</p><p>Authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 7","pages":"849-850"},"PeriodicalIF":5.0000,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14813","citationCount":"0","resultStr":"{\"title\":\"Novel clip closure technique for a large mucosal defect with anchor-pronged clips after duodenal endoscopic submucosal dissection\",\"authors\":\"Kohei Shigeta, Noboru Kawata, Hiroyuki Ono\",\"doi\":\"10.1111/den.14813\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p>Duodenal endoscopic submucosal dissection (DESD) has a high incidence of delayed adverse events (AEs).<span><sup>1</sup></span> However, complete mucosal closure (CMC) can reduce the risk of AEs after DESD.<span><sup>2</sup></span> Conventional clip closure is a common technique,<span><sup>1</sup></span> but it poses challenges when used for CMC of large defects after DESD. This case shows a simple closure technique using anchor-pronged clips (MANTIS clip; Boston Scientific, Waltham, MA, USA) for CMC after DESD.</p><p>A 63-year-old man underwent DESD for a 40 mm flat elevated lesion in the descending duodenum (Fig. 1a). During the DESD, an intraprocedural perforation occurred, which was closed using a conventional clip (SureClip; Micro-tech, Nanjing, China). Then en bloc resection was performed on a 47 × 41 mm specimen (Fig. 1b). After resection, mucosal closure was initiated with the anchor-pronged clips for the approximately half circumferential defect (Fig. 2a,b). We grasped the oral edge of the defect using the anchor-pronged clip, allowing us to bring and grasp the opposite side (Video S1). The anchor-pronged clip closed the center of the defect (Fig. 2c), and CMC was achieved in 11 min using seven additional conventional clips (Fig. 2d). The patient was discharged 6 days later without AEs. Pathological examination revealed the lesion was an intramucosal well-differentiated adenocarcinoma with negative resection margins.</p><p>Although there are various techniques for CMC after DESD,<span><sup>1</sup></span> some of these methods require technical skills. Anchor-pronged clip closure is a simple technique that enables the closure of larger defects and overcomes the challenges of conventional clips during the closure procedure, such as tissue slippage when grasping the opposite side.<span><sup>3, 4</sup></span> Furthermore, by applying the previously reported technique of anchor-pronged clip to grasp and suture the muscle layer, it may be possible to reduce suture-induced dead space even in the duodenum.<span><sup>5</sup></span> Therefore, mucosal closure using anchor-pronged clips is a viable option for CMC of large defects after DESD.</p><p>Authors declare no conflict of interest for this article.</p>\",\"PeriodicalId\":159,\"journal\":{\"name\":\"Digestive Endoscopy\",\"volume\":\"36 7\",\"pages\":\"849-850\"},\"PeriodicalIF\":5.0000,\"publicationDate\":\"2024-05-07\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14813\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Digestive Endoscopy\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1111/den.14813\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Digestive Endoscopy","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/den.14813","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
Novel clip closure technique for a large mucosal defect with anchor-pronged clips after duodenal endoscopic submucosal dissection
Duodenal endoscopic submucosal dissection (DESD) has a high incidence of delayed adverse events (AEs).1 However, complete mucosal closure (CMC) can reduce the risk of AEs after DESD.2 Conventional clip closure is a common technique,1 but it poses challenges when used for CMC of large defects after DESD. This case shows a simple closure technique using anchor-pronged clips (MANTIS clip; Boston Scientific, Waltham, MA, USA) for CMC after DESD.
A 63-year-old man underwent DESD for a 40 mm flat elevated lesion in the descending duodenum (Fig. 1a). During the DESD, an intraprocedural perforation occurred, which was closed using a conventional clip (SureClip; Micro-tech, Nanjing, China). Then en bloc resection was performed on a 47 × 41 mm specimen (Fig. 1b). After resection, mucosal closure was initiated with the anchor-pronged clips for the approximately half circumferential defect (Fig. 2a,b). We grasped the oral edge of the defect using the anchor-pronged clip, allowing us to bring and grasp the opposite side (Video S1). The anchor-pronged clip closed the center of the defect (Fig. 2c), and CMC was achieved in 11 min using seven additional conventional clips (Fig. 2d). The patient was discharged 6 days later without AEs. Pathological examination revealed the lesion was an intramucosal well-differentiated adenocarcinoma with negative resection margins.
Although there are various techniques for CMC after DESD,1 some of these methods require technical skills. Anchor-pronged clip closure is a simple technique that enables the closure of larger defects and overcomes the challenges of conventional clips during the closure procedure, such as tissue slippage when grasping the opposite side.3, 4 Furthermore, by applying the previously reported technique of anchor-pronged clip to grasp and suture the muscle layer, it may be possible to reduce suture-induced dead space even in the duodenum.5 Therefore, mucosal closure using anchor-pronged clips is a viable option for CMC of large defects after DESD.
Authors declare no conflict of interest for this article.
期刊介绍：
Digestive Endoscopy (DEN) is the official journal of the Japan Gastroenterological Endoscopy Society, the Asian Pacific Society for Digestive Endoscopy and the World Endoscopy Organization. Digestive Endoscopy serves as a medium for presenting original articles that offer significant contributions to knowledge in the broad field of endoscopy. The Journal also includes Reviews, Original Articles, How I Do It, Case Reports (only of exceptional interest and novelty are accepted), Letters, Techniques and Images, abstracts and news items that may be of interest to endoscopists.
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