Over-the-scope clip closure with dual thin grasping forceps after gastric endoscopic submucosal dissection

Abstract

Postoperative bleeding and perforation are common complications of gastric endoscopic submucosal dissection (ESD),¹ and closure is a topic. However, closures are often complicated.^{2, 3} Nishiyama et al.⁴ described the use of novel thin grasping forceps for over-the-scope clip (OTSC) closure after endoscopic full-thickness resection. The grasping forceps (TechGrasper; Micro-Tech, Nanjing, China) offers two main advantages. The forceps' small diameter does not interfere with suction applied before the OTSC deployment, and the strong grasping power ensures reliable staple application to the muscle layer. Here, we report the first case of successful ulcer closure after gastric ESD using TechGrasper-assisted OTSC.

A 78-year-old man with lung adenocarcinoma underwent esophagogastroduodenoscopy for preoperative screening, which revealed a 30 mm gastric cancer. Although the patient was a candidate for ESD, lung resection was prioritized because of advanced-stage lung cancer (pT2aN2M0, pStage IIIA). Postoperative adjuvant chemotherapy including regimens associated with increased risk of perforation and thrombocytopenia was recommended. Therefore, before chemotherapy initiation, the patient underwent TechGrasper-assisted OTSC closure of the post-ESD ulcer, which measured 50 × 34 mm in diameter (Fig. 1a,b).⁵ Briefly, immediately after ESD, an OTSC (Ovesco Endoscopy GmbH, Tuebingen, Germany) was attached to the tip of a two channel endoscope (GIF-2TQ260M; Olympus Co., Tokyo, Japan). After grasping the edge of the post-ESD ulcer, the TechGraspers were pulled into the cap of the OTSC, which was then released with sufficient suction (Fig. 1c,d). The endoscopist pulled and adjusted one pair of forceps, and the assistant pulled the other pair of forceps. Four OTSCs were successfully applied to the post-ESD ulcer (Fig. 2a and Video S1). The patient underwent adjuvant chemotherapy 4 weeks after ESD, without subsequent adverse events (Fig. 2b–d). The present case illustrates the utility of TechGrasper-assisted OTSC as a simple technique to promote effective wound healing following gastric ESD.

Authors declare no conflict of interest for this article.