Successful closure using endoscopic ligation with O-ring and over-the-scope clip in gastric iatrogenic perforation

摘要

Closure using a conventional hemoclip is limited to managing immediate large perforations during endoscopic submucosal dissection (ESD). Innovative closure techniques using an over-the-scope clip (OTSC) with endoloop and others have been developed [1]; however, this requires familiarity with a single-channel scope to make sure that full-thickness closure is achieved without delayed leakage. For approximating large perforations with the aid of a Twin Grasper ([TG], Ovesco Endoscopy), using OTSC is challenging because of the difficulty in maneuvering the TG and the risk of insufflation leakage [2]. The technique of endoscopic ligation with O-ring closure (E-LOC) that we have developed [3] seems advantageous for overcoming this problem. Here we describe the successful closure of a large iatrogenic perforation using E-LOC followed by OTSC.