Gastric defect closure with reopenable clip over-the-line method and dual-action tissue clip for 3-point fixation

After endoscopic submucosal dissection (ESD) of the stomach, defect closure is difficult because a submucosal dead space (SDS) is created by the thick muscle layer and mucosa, even with the use of ordinary clips alone [1]. Therefore, we devised the reopenable clip over-the-line method (ROLM), which enables the amount of SDS to be reduced [2] [3] [4]. However, this method is time consuming. Therefore, we further devised a method that uses ROLM and the dual-action tissue (DAT) clip for 3-point fixation for defect closure ([Fig. 1], [Video 1]).