Feasibility study on endoscopic suture with the combination of a distal attachment and a rotatable clip for complications of endoscopic resection in the large intestine

Background and Study Aims: Endoscopic resection has been more frequently pe rformed for increasingly larger intramucosal tumors of the large intestine in recent years. It is reasonable to expect that the larger the resected mu cosal surface, the greater is the likelihood of complications such as bleed ing or perforation. The aim of this study was to explore the feasibility of endoscopic suture with a distal attachment and a rotatable clip-fixing dev ice for complications of endoscopic resection in the large intestine. Patients and Methods: The study population consisted of 15 patients who und erwent endoscopic clipping therapy following endoscopic resection for intra mucosal tumors of the large intestine. With a distal attachment fitted to t he distal end of the endoscope, the optimal position for clipping was ensur ed by pressing the intestinal wall and deflating the intraluminal air littl e by little. With a rotatable clip-fixing device, the resection site was en doscopically sutured clip by clip, Results: Tumors were of the laterally spreading tumor type in six patients, small sessile polyps in three, and pedunculated polyps in six. The complic ations consisted of bleeding in 12 patients, overt perforation in one, and latent perforation in two; 14 of the 15 patients underwent successful sutur ing by this method. The number of clips used ranged from two to seven (mean 4.4), No patients had further complications after the treatment. Conclusion: We conclude that endoscopic suture with the combination of a di stal attachment and a rotatable clip-fixing device is very useful for compl ications of endoscopic resection in the large intestine.