A novel “twist-and-drag” loop clip technique for closure of mucosal defects after colorectal endoscopic submucosal dissection

A novel "twist-and-drag" loop clip technique for closure of mucosal defects after colorectal endoscopic submucosal dissection Fig. 3 Twist-and-drag loop clip closure using double-layered suturing for large mucosal defects.a Conventional clips were applied directly to the muscular layer.b The clip with an elastic band was placed at the oral edge of the defect.c The elastic band was hooked using a reopenable clip, and the clip was twisted to wrap the elastic band around it.d The clip was dragged to the anal edge of the defect.e The clip was deployed after grasping both sides of the defect edge.f Complete closure of the mucosal defect was achieved by applying additional clips.