title: New closure technique for large mucosal defects after endoscopic submucosal dissection of colorectal tumors (with video).
abstract: BACKGROUND
  Certain large colorectal tumors satisfy expanded indications for endoscopic submucosal dissection (ESD); however, the resulting large mucosal defects may contribute to complications such as delayed bleeding and perforation. Various closure devices and methods have been developed for large mucosal defects to prevent such complications.
  
  
  OBJECTIVE
  To demonstrate the feasibility of a new and simple technique for closing large mucosal defects after colorectal ESD.
  
  
  METHODS
  Pilot feasibility study.
  
  
  METHODS
  Single center.
  
  
  METHODS
  Ten patients with 10 tumors half circumferential or less in size with sufficient muscle layer exposure after ESD were selected and treated by using the closure technique between July 2009 and June 2010.
  
  
  METHODS
  Small mucosal incisions were made around the mucosal defect by the same needle-knife used during ESD. These incisions provided a better grip for conventional clips, which then facilitated lifting the surrounding mucosa across the defect without slipping, thereby making it considerably easier to reduce the size of the defect and place additional clips.
  
  
  METHODS
  Patient characteristics and tumor clinicopathologic features were assessed as well as closure completion rate, closure procedure time, and closure-related complications.
  
  
  RESULTS
  All 10 tumors were successfully treated by ESD. Mean lesion size was 26.8 mm (range 8-50 mm). All mucosal defects were completely closed by using the new closure technique, without complications. Mean closure procedure time was 15 minutes (range 8-35 minutes).
  
  
  CONCLUSIONS
  Small sample size with specifically selected patients.
  
  
  CONCLUSIONS
  Large mucosal defects resulting from colorectal ESD can be completely closed with small mucosal incisions by using conventional clips.
authors.affiliation: Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Otake
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Saito
authors.forename: Taku
authors.initials: T
authors.lastname: Sakamoto
authors.forename: Takaya
authors.initials: T
authors.lastname: Aoki
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nakajima
authors.forename: Naoya
authors.initials: N
authors.lastname: Toyoshima
authors.forename: Takahisa
authors.initials: T
authors.lastname: Matsuda
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Ono
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D058106:Wound Closure Techniques