Clin Endosc.  2022 Jul;55(4):525-531. 10.5946/ce.2021.241.

Application of a traction metal clip with a fishhook-like device in wound sutures after endoscopic resection

• Fangjun W
• Xia L
• Yi G
• Xiuyun S
• Wenping W
• Huamin L
• Pengfei L

• KMID: 2531946
• DOI: http://doi.org/10.5946/ce.2021.241

Abstract

Background/Aims
Endoscopic wound suturing is an important factor that affects the ability to remove large and full-thickness lesions during endoscopic resection. We aimed to evaluate the effect of a traction metal clip with a fishhook-like device on wound sutures after endoscopic resection.
Methods
From July 2020 to April 2021, patients who met the enrollment criteria were treated with a fishhook-like device during the operation to suture the postoperative wound (group A). Patients with similar conditions and similar size wounds who were treated with a “purse-string suture” to suture the wounds were retrospectively analyzed as the control group (group B). Difference in the suture rate, adverse events, time required for suturing, and number of metal clips were compared between the two groups.
Results
The time required for suturing was 7.72±0.51 minutes in group A and 11.50±0.91 minutes in group B. This difference was statistically significant (F=13.071, p=0.001). The number of metal clamps used in group A averaged 8.1 pieces/case, and the number of metal clamps used in group B averaged 7.3 pieces/case. This difference was not statistically significant (F=0.971, p>0.05).
Conclusions
The traction metal clip with the fishhook-like device is ingeniously designed and easy to operate. It has a good suture effect on the wound after endoscopic submucosal dissection and effectively prevents postoperative adverse events.

Keyword

Endoscopic resection; Fishhook traction clip; Purse-string suture; Surgical instruments; Suture techniques; Wound suture

Figure

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  Fig. 1. Fishhook traction clip. (A) When the traction clip is opened, the fishhook-like structure can penetrate the mucosal surface. (B) When the traction clip is closed, the fishhook-like structure prevents the mucosa from falling.

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  Fig. 2. The procedure of endoscopic submucosal dissection using fishhook traction clips to suture the wound. (A) A submucosal tumor on the greater curvature of the stomach, approximately 1.0×1.0 cm. (B) After removing the lesion, the wound area was approximately 2.0×3.0 cm. (C) A fishhook traction clip was used to clamp the mucosa on the side edge of the wound. (D) The mucosa was lifted so that the hook-like device penetrated the mucosa. (E) The fishhook traction clip was opened, and the mucosa was pushed from the oral side to the anal side. (F) The anal mucosa of the wound was clamped, and the wound orifice and anal side were seamed. (G) The reduced wound was sutured with ordinary metal clips. (H) The wound was sutured well.

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  Fig. 3. The procedure of endoscopic submucosal dissection using purse-string suture. (A) A submucosal tumor about 1.8×1.5 cm in the posterior wall of the upper gastric body. (B) Make circular incision of the mucosa, expose the lesion, and peel off the tumor. (C) The wound after resection was about 2.5×3.0 cm, with 2 mm small perforations locally. (D) The first metal clip fixes the nylon rope on the distal side of the wound. (E) Use metal clips to fix the nylon rope around the wound several times. (F) Finally tighten the nylon rope to suture the wound.

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  Fig. 4. Box plots of observation index comparison. These four groups of data can be statistically compared, and box plots are used to compare the data more intuitively. (A) Comparison of the age of the two groups. (B) Comparison of the wound size of the two groups. (C) Comparison of the suture time of the two groups. (D) Comparison of the number of clips of the two groups.

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