LAUSR

Complete closure of a mucosal defect using a clip with a transparent cylindrical hood reduces the occurrence of adverse incidents after colorectal endoscopic submucosal dissection (ESD) [1]. Thus, we developed the “reopenable clip over the line method” (ROLM), a technique that uses a line and a reopenable clip (SureClip, 16 mm; MC Medical, Tokyo, Japan) to close a mucosal defect after ESD [2]. With the ROLM, the mucosal defect can be closed completely without clipping its edges on both sides [3]. However, when a cylindrical hood is used, there is a risk that the clip could enter the hood and impede the endoscopic view (▶Fig. 1 a, b). For this reason, we performed the ROLM using a calibrated, small-caliber-tip, transparent hood (CAST hood; TOP, Tokyo, Japan), to prevent the clips deployed for the mucosal defect closure from interfering with the endoscopic view (▶Fig. 1 c, d). The CAST hood is a tapered hood with a 4-mm tip [4] that allows the clips that are fixed to close the mucosal defect to be deflected out of the hood by the edges of the hood. It can also be used under water to maintain the endoscopic field of view intraoperatively [5]. In our case, the patient had early rectal cancer that was completely resected by ESD. The resected mucosal defect was approximately 5 cm in size, straddled the folds, and was completely closed using the ROLM with a CAST hood (▶Fig. 2; ▶Video 1). The reopenable clips did not interfere with the endoscopic view during the ROLM. A cylindrical hood with a large diameter is not always necessary because the ROLM allows themucosal defect to be closed by grasping only the defect and the nearby muscularis propria, without grasping the edges on both sides of the mucosal defect.