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Objectives: Large mucosal defects following gastric endoscopic submucosal dissection (ESD) cause postoperative bleeding. To address this limitation and ensure closure of large mucosal defects, we developed the reopenable clip‐over‐the‐line method (ROLM) using a reopenable clip and nylon line. The purpose of this study was to evaluate the feasibility of the ROLM for closure of large mucosal defects following gastric ESD in a prospective, consecutive series of cases. Methods: We performed the ROLM on 50 consecutive patients with gastric mucosal defects at the Ise Red Cross Hospital and Mie Prefectural Shima Hospital. The time to complete the ROLM, numbers of clips and lines required, size of defect, and closure success rate were measured, and postoperative adverse events were recorded. Results: In all, 50 lesions were included in this study period between July 2021 and March 2022. The success rates of defect closure and defect closure without submucosal dead space of the ROLM were both 100% (50/50), with a median ROLM time of 30 (range, 14–35) min and a median resected specimen major axis of 45 (range, 31–73) mm. The median number of reopenable clips used was 31 (range, 10–93). Following gastric ESD, two cases of post‐ESD bleeding were observed during the follow‐up periods. Conclusion: Our results suggest that ROLM is a feasible strategy for complete closure of mucosal defects post‐ESD without submucosal dead space. Future comparative studies with post‐ESD bleeding rate as the main outcome are desirable to evaluate the efficacy of ROLM. [ABSTRACT FROM AUTHOR]

Endoscopic submucosal dissection is an established method for complete resection of large and early gastrointestinal tumors. However, methods to reduce bleeding, perforation, and other adverse events after endoscopic resection (ER) have not yet been defined. Mucosal defect closure is often performed endoscopically with a clip. Recently, reopenable clips and large‐teeth clips have also been developed. The over‐the‐scope clip enables complete defect closure by withdrawing the endoscope once and attaching the clip. Other methods involve attaching the clip‐line or a ring with an anchor to appose the edges of the mucosal defect, followed by the use of an additional clip for defect closure. Since clips are limited by their grasping force and size, other methods, such as endoloop closure, endoscopic ligation with O‐ring closure, and the reopenable clip over‐the‐line method, have been developed. In recent years, techniques often utilized for full‐thickness ER of submucosal tumors have been widely used in full‐thickness defect closure. Specialized devices and techniques for defect closure have also been developed, including the curved needle and line, stitches, and an endoscopic tack and suture device. These clips and suture devices are applied for defect closure in emergency endoscopy, accidental perforations, and acute and chronic fistulas. Although endoscopic defect closure with clips has a high success rate, endoscopists need to simplify and promote endoscopic closure techniques to prevent adverse events after ER. [ABSTRACT FROM AUTHOR]

Defect closure was performed using the ROLM, a defect closure technique using a line and reopenable clip (SureClip 8 mm, 16 mm; MicroTech, Nanjing, China) [3]. Mucosal defect closure after gastric endoscopic submucosal dissection (ESD) is challenging because of the thick mucosal and muscle layers [1]; it is particularly difficult in the gastric antrum. [Extracted from the article]

Background and Aim: Endoscopic stone removal has some complications. Although the life expectancy of elderly patients has increased dramatically worldwide, little information is available on the necessity of complete endoscopic stone removal in extremely elderly patients. This study aimed to evaluate the safety and efficacy of complete endoscopic stone removal in extremely elderly patients. Methods: All extremely elderly patients (>90 years) who underwent endoscopic stone removal for choledocholithiasis at our hospital between January 2012 and January 2017 were retrospectively evaluated. The included patients were divided into complete stone removal and incomplete stone removal groups. Complication rate, overall survival (OS), and disease‐specific survival (DSS) rates were compared between the two groups. Results: Overall, 73 patients were included in this study. The median number of stones was one (range, 0–10) and two (range, 1–12) (P = 0.043), while the median diameter of the largest stones was 9 (range, 0–27) and 14 (range, 5–46) mm (P = 0.001) in the complete and incomplete stone removal groups, respectively. During the follow‐up period, OS was 60% and 39% and DSS was 95% and 97% in the complete and incomplete stone removal groups, respectively. Kaplan–Meier analysis found no significant difference in OS and DSS between the two groups (P = 0.052 and P = 0.646, respectively). Conclusion: Complete stone removal might not always be necessary in extremely elderly patients aged ≥90 years. [ABSTRACT FROM AUTHOR]