title: A novel grasp-and-loop closure method for defect closure after endoscopic full-thickness resection (with video).
abstract: Endoscopic full-thickness resection (EFTR) is a minimally invasive method for en bloc resection of gastrointestinal (GI) lesions originating from the muscularis propria layer. Successful closure of the wall defect is a critical step.
  
  
  
  The aim of this study was to evaluate the feasibility and efficacy of a novel and simplified endoscopic grasp-and-loop (GAL) closure method using an endo-loop assisted with grasping forceps for defect closure.
  
  
  
  From January 2015 to March 2016, 13 patients with submucosal tumors (SMTs) originating from the muscularis propria (MP) layer underwent EFTR and were enrolled in this study. After successful tumor resection, an endo-loop was anchored onto the circumferential margin of the gastric defect with grasping forceps assistance and tightened gently. Patient characteristics, tumor size, en bloc resection, and postoperative complications were evaluated.
  
  
  
  Of the 13 lesions in the stomach, two were located in the greater curvature of the mid-upper body, 11 were located in the fundus. The endoscopic GAL closure method was successfully performed after EFTR in all the 13 patients without laparoscopic assistance. The mean procedure time was 43.5 min (range 20-80 min), while the GAL closure procedure took a mean of 9.4 min (range 3-18 min). The mean resected lesion size was 1.5 cm (range 0.5-3.5 cm). Pathological diagnoses of these lesions were 11 gastrointestinal stromal tumors (GISTs) and two leiomyomas. No major adverse events occurred during or after the procedure. All the patients were discharged after a mean time of 2.4 days (range 1-4 days). No residual lesion or tumor recurrence was found during the follow-up period (median, 5 months; range, 1-15 months).
  
  
  
  The endoscopic GAL closure method is feasible, effective, and safe for closing the gastric defect after EFTR in patients.
authors.affiliation: Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China.
authors.forename: Jian-Wei
authors.initials: JW
authors.lastname: Hu
authors.affiliation: Department of Gastrointestinal Surgery, Affiliated Tumor Hospital, Xinjiang Medical University, Urumuqi, 830011, People's Republic of China.
authors.forename: Lei
authors.initials: L
authors.lastname: Ge
authors.affiliation: Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China.
authors.forename: Ping-Hong
authors.initials: PH
authors.lastname: Zhou
authors.affiliation: Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China.
authors.forename: Quan-Lin
authors.initials: QL
authors.lastname: Li
authors.affiliation: Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China.
authors.forename: Yi-Qun
authors.initials: YQ
authors.lastname: Zhang
authors.affiliation: Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China.
authors.forename: Wei-Feng
authors.initials: WF
authors.lastname: Chen
authors.affiliation: Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China.
authors.forename: Tao
authors.initials: T
authors.lastname: Chen
authors.affiliation: Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China.
authors.forename: Li-Qing
authors.initials: LQ
authors.lastname: Yao
authors.affiliation: Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China. xu.meidong@zs-hospital.sh.cn.
authors.forename: Mei-Dong
authors.initials: MD
authors.lastname: Xu
authors.affiliation: Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Chu
mesh_terms: D000328:Adult; D000368:Aged; D000069916:Endoscopic Mucosal Resection / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D046152:Gastrointestinal Stromal Tumors / Q000601:surgery; D006801:Humans; D007889:Leiomyoma / Q000601:surgery; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D013274:Stomach Neoplasms / Q000601:surgery*
keywords: Endoscopic closure technique; Endoscopic full-thickness resection; Endoscopic surgical procedure; Gastric perforation; Gastric submucosal tumors