Endoscopic closure of the defect after endoscopic submucosal resection with metal clips and surgical sutures Wei Wang, MD, Lu Jin, MD, Fei Zhao, MD,

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Endoscopic closure of the defect after endoscopic submucosal resection with metal clips and surgical sutures Wei Wang, MD, Lu Jin, MD, Fei Zhao, MD, Ke Qi, MD, Zhendong Jin, MD VideoGIE Volume 4, Issue 1, Pages 22-23 (January 2019) DOI: 10.1016/j.vgie.2018.09.007 Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 1 Endoscopic closure schema with metal clips and surgical sutures. A, A surgical suture was tied to 1 tooth of the first clip, and a small loop was made. The diameter of the loop should be no more than the width of an open clip. B and C, The first clip was fixed on 1 side of the defect. D, One tooth of the second clip was inserted into the loop of the first clip and moved close to the contralateral side. E, The second clip was fixed on the contralateral side of the defect. F, The residual incision was completely closed with more clips. VideoGIE 2019 4, 22-23DOI: (10.1016/j.vgie.2018.09.007) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 2 Endoscopic closure of the gastric wall defect with metal clips and surgical sutures. A, The first clip was fixed on the mouth side of the defect. B, One tooth of the second clip was inserted into the loop of the first clip. C, The second clip was fixed on the anal side of the defect. D, The defect was completely closed with more clips. VideoGIE 2019 4, 22-23DOI: (10.1016/j.vgie.2018.09.007) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 3 Histopathologic view indicating that the lesion was a leiomyoma. VideoGIE 2019 4, 22-23DOI: (10.1016/j.vgie.2018.09.007) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions