Endoscopic slipknot clip suturing method: An ex vivo feasibility study (with video)

Background and Aims We developed a suturing method with slipknot string and clips for the single-channel endoscope. The aim of this study was to analyze the efficacy of the slipknot clip suturing method. Methods Twelve 30-mm mucosal defects were created by endoscopic submucosal dissection in an ex vivo bovine model. A slipknot is a type of knot that can "slip" along the string. The loop can be tightened when tension is applied to the free end of the string. The clip and string can be passed through the instrument channel of the single-channel endoscope. The slipknot loop is anchored on the mucosal defect's proximal margin with the clip. An additional clip anchored at the slipknot loop is placed on a different side of the margin. The slipknot loop is tightened by pulling the string. Additional clips are placed to achieve complete closure. Results All 12 defects were completely closed by the slipknot clip suturing method. The procedure time decreased significantly from the first 6 procedures to the last 6 procedures (865 ± 213 vs 556 ± 103 seconds, P =.009). Conclusions The slipknot clip suturing method makes it easy to close a large mucosal defect completely by using a single-channel endoscope.