Rubber band-assisted closure of a mucosal defect following duodenal EMR

摘要

EMR of large duodenal adenomas is a technically chal- lenging procedure. It carries a particularly high risk of perforation (5%-10%) because of its relatively thin and fixed wall and delayed bleeding (15%) due to its rich vascular supply. 1 Systematic closure of mucosal defects after duodenal endoscopic resection has been found to significantly reduce the risk of delayed adverse events (AEs) by 80%, specifically the risk of delayed bleeding and perforation. 2 However, owing to the fixed retroperitoneal descending duodenum, apposition of the 2 mucosal edges is not always feasible, making closure using standard clips challenging. We describe a simple and safe technique using an inexpensive and widely available rubber band and standard endoscopic clips (Video 1, available online at www.giejournal.org).