Efficacy and Cost-Effectiveness of a Novel Dual Gasping Forceps-Assisted Over-the-scope Clip Inverted Closure after Gastric Endoscopic Full-Thickness Resection.

Achieving reliable full-thickness defect closure after gastric endoscopic fullthickness resection (EFTR) for gastrointestinal stromal tumors is challenging [1, 2]. Although mucosal closure appears clinically acceptable [2–4], it is crucial to develop a robust and technically easy closure method that enables serosa-serosa inverted closure, as with surgical sutures. Here, we describe a novel dual slim grasping forceps-assisted over-the-scope (OTS) clip closure under dual-channel endoscopy in gastric EFTR.With this technique, the difficult maneuvers and high cost associated with Twin Grasper forceps (Ovesco Endoscopy GmbH, Tübingen, Germany) can be overcome. A 65-year-old man presented with a gastrointestinal stromal tumor in the upper stomach. After standard EFTR, a full-thickness defect measuring 15mm in diameter remained (▶Fig. 1 a). After obtaining written informed consent, the defect was closed according to the following description (▶Fig. 2, ▶Video 1). The equipment comprised two grasping forceps (TechGrasper; Micro-Tech, Nanjing, China) (cost US$24) instead of the Twin Grasper forceps (cost US$694). TechGrasper forceps have two advantages: the slim shaft (1.8mm outer diam▶ Fig. 1 Endoscopic images. a After standard full-thickness resection, a defect measuring 15mm in diameter remained. b Two grasping forceps were inserted into the gastroscope’s dual channels mounted with an over-the-scope (OTS) clip, and the seromuscular layers on both sides of the defect were grasped. c The two grasping forceps were pulled into the OTS clip cap under sufficient suction, and the OTS clip was deployed.