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Release and re-hook: a novel method with combined use of clips and nylon snare to close a colonic defect after endoscopic mucosal resection

The application of two accessories with a single- channel endoscope is either challenging or impossible. Perforations and large mucosal defects can be closed with the combined use of clips and a nylon snare using two methods. In the “tulip- bundle” technique the snare is lassoed and tightened over a bundle of clips attached at the edges of the tear. In the “purse-string” technique, the snare forms a nylon loop that is clipped around the edges of the lesion. Closure is accomplished by closing the snare. However, with the tulip-bundle technique, there is a risk of the snare slipping over the clips, whereas the purse- string approach requires the use of a double- channel endoscope, or the snare must be fixed externally to the scope. In addition, it can be difficult to operate a double-channel endoscope or to maintain the position of an externally fixed snare in a redundant or tortuous colon.

colonoscopy, polypectomy, endoscopic resection

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