Clinical usefulness of the hold-and-drag closure using the SB clip for large mucosal defects after colorectal endoscopic submucosal dissection

Background Endoscopic clip closure of mucosal defects after colorectal endoscopic submucosal dissection (ESD) reduces the risk of postoperative adverse events, but achieving complete closure for large mucosal defects can be difficult. The aim of this study was to evaluate the effectiveness of the hold-and-drag closure using an SB clip compared with that of the conventional closure for mucosal defects after colorectal ESD. Methods Eighty-four consecutive colorectal lesions resected by ESD at the Hiroshima Asa Citizens Hospital were registered and randomly allocated to two groups (Group A: SB clip, Group B: EZ clip), and then endoscopic closures were performed. We crossed-over to the SB clip in situations where the initial closure using an EZ clip was unsuccessful in achieving complete closure. Outcomes were compared and analyzed. Results Forty-two lesions were randomly assigned to groups A and B. The complete closure rate was significantly higher in group A, especially in resected specimens with a diameter of 30 mm or more. Twelve lesions that failed complete closure in group B were changed to SB clips, and 95% of the whole of group B were successfully closed. There were no significant differences in procedural time, number of clips, and cost of clips between groups A and B. Conclusion Compared with the conventional closure, the hold-and-drag closure using an SB clip is a more suitable method for complete closure, especially for large mucosal defects of 30 mm or more. Furthermore, this is a simpler and more economical compared to a zipper closure using EZ clips.