Novel strategy of hold-and-drag clip closure with mantis-like claw for post-gastric endoscopic submucosal dissection defect of <30 mm

Endoscopic closure of post-endoscopic submucosal dissection (ESD) defects can reduce postoperative adverse events [1]. Innovative techniques such as use of an endoloop [2], endoscopic ligation with O-ring closure [3], and reopenable clip over the line method [4] have recently been developed; however, the complexity and time-consuming nature of such procedures remain problematic. We introduce a closure strategy using a new endoclip with a mantis-like claw (MANTIS Clip; Boston Scientific, Marlborough, Massachusetts, USA) ([Fig. 1]) that enables a secure hold-and-drag maneuver and defect approximation in gastric post-ESD defects ([Fig. 2]).