Cinch-modified reopenable clip over-the-line method for mucosal defect closure.

BACKGROUND AND AIMS: Endoscopic mucosal defect closure is essential to prevent adverse events after advanced endoscopic resection. The reopenable clip over-the-line method (ROLM) is effective for large defects but remains technically demanding, particularly during suture fixation and cutting. We present a simplified modification using an endoscopic cinch device.

METHODS

The cinch-modified ROLM (C-ROLM) incorporates an endoscopic cinch device to simultaneously fix and cut the suture line in a single step. After sequential approximation of mucosal defect edges using a reopenable hemostatic clip threaded with a surgical suture, the cinch device is advanced over the suture, tension is adjusted, and the cinch is deployed to secure closure.

RESULTS

C-ROLM was successfully applied to close a 3-cm colonic mucosal defect after endoscopic submucosal dissection in a 78-year-old woman. Complete closure was achieved in 16.5 minutes without technical difficulty or adverse events.

CONCLUSIONS

C-ROLM simplifies the most technically challenging steps of ROLM and may facilitate efficient closure of large mucosal defects, potentially reducing postprocedural adverse events.