LAUSR

Gastrointestinal perforation is a common complication of endoscopic therapy, especially with some novel approaches such as endoscopic submucosal dissection (ESD) [1], that can lead to serious or even life-threatening outcomes if not handled properly. With the rapid development of endoscopic techniques, various endoscopic suture methods for closing the defect have been reported [2–4]. However, most of the closure devices are expensive and require complicated manipulation. Consequently, it is still difficult to handle endoscopic perforation effectively in clinical practice [5]. We report here a novel suturing strategy using barbed string that is easy to master and is cheaper than other available suturing methods. A 50-year-old woman with a submucosal tumor located in the upper lesser curve of the stomach was referred to our hospital (▶Fig. 1 a). ESD surgery was performed that left a wound site defect 2.5 ×1.5 cm in size (▶Fig. 1b). It was difficult to reach the site of the lesion. Moreover, the tension of the lesion was too great to allow two edges to be clipped together, and the stomach wall was so thick that clips alone could not be used for full-thickness closure of the defect. Therefore, we used absorbable wound closure barbed string (▶Fig. 2), selecting a length of 5 cm based on the size of the defect. First, a reopenable clip with the barbed string attached was deployed on one edge of the defect gripping the full thickness of the gastric wall layers (▶Fig. 1 c). Another two clips were separately used to draw the barbed string E-Videos