Endoscopic closure using SureClip Traction Band for delayed perforation after colorectal endoscopic submucosal dissection

Delayed perforation (DP) is reported to occur in 0.1–0.4% of colorectal endoscopic submucosal dissection (ESD).^{1, 2} DP can be fatal due to peritonitis and most cases of colorectal DP result in surgery. Various endoscopic closures after ESD are reported for preventing DP.^{3, 4} However, few reports showed the success of endoscopic closure for DP.⁵ In this report, we present a case of DP closed with SureClip Traction Band (SCTB; Micro-Tech Co., Nanjing, China). The patient was a 61-year-old woman. She took prednisolone 10 mg/day for Wegener's granulomatosis. A polypoid lesion of 25 mm was detected in the transverse colon (Fig. 1a). En bloc resection was performed with ESD. The ESD defect was closed using MANTIS Closure Device (Boston Scientific, Marlborough, MA, USA) and SureClip (Micro-Tech Co.), considering the negative impact of prednisolone for would healing (Fig. 1b,c). However, tight complete closure was not achieved due to difficult operability. On the day after ESD, the patient presented abdominal pain and computed tomography (CT) showed free air (Fig. 1d). Because of the localized peritonitis, we decided to close it endoscopically. Although no perforation was found, we performed additional closure with SureClip (Fig. 1e,f). However, 3 days after ESD, free air increased with CT (Fig. 2a). Endoscopic closure was performed again and contrast medium leakage was observed (Fig. 2b). The ulcer base was hard and previous clips remained, making closure difficult. Normal mucosa at the edge of the ulcer on the anal side was captured with SCTB. Then the band was gripped with SureClip and deployed at the oral side of the ulcer for closing the ESD defect. Finally, complete closure could be performed with additional SCTB and SureClip (Fig. 2c–f, Video S1). The patient was discharged 11 days after ESD.

Author N.Y. had a grant from Fujifilm and received a lecture fee from Fujifilm. The other authors have no conflicts of interest for this article.