“Loop-10” line-assisted clip closure method: closure of perforation in re-do peroral endoscopic myotomy

Abstract

Complete closure of mucosal defect is essential, especially when a full-layer resection is intentionally performed or when we encounter unintentional tissue perforation. A standard method for closing a large mucosal defect has not yet been established. It is technically demanding to close a large-size tissue defect solely by endoscopic clips. A line-assisted clip closure technique has been reported to overcome technical difficulties.1-8 In principle, by pulling a thread anchored to the first clip, the succeeding clips can be efficiently and effectively applied to approximate mucosal edges with adequate tissue traction.