ASGE-JGES Endoscopic Submucosal Dissection ESD (On-demand) | October 2025-LAB - Advanced ESD Techniques - Closure with Water-Pressure-Origami Method

LAB - Advanced ESD Techniques - Closure with Water-Pressure-Origami Method - Akimoto

Video Transcription

Video Summary

In this session, Dr. Teppei Akimoto from Keio University demonstrates the "origami technique" for closure of post-ESD (endoscopic submucosal dissection) defects, focusing on a challenging stomach case. Originally developed for colorectal and duodenal ESD defects, this method involves using a re-openable Microtech 60mm clip to grasp and invert the muscular layer, creating "muscle mountains" to effectively reduce defect size and achieve closure. This approach minimizes mucosal tearing compared to approximating mucosal edges alone. The technique allows closure of defects up to 75% size in the colon and rectum, requiring 15-25 clip grips. It is effective even with exposed or injured muscular layers, as the inversion suffices for closure. Dr. Akimoto prefers Microtech clips over mantis or obesko clips because they allow detachment over time, reducing scar formation. Managing stomach insufflation is critical to maintain closure. This cost-effective method suits facilities without advanced suturing devices and enhances safety by preventing delayed perforations.

Keywords

origami technique

post-ESD defect closure

Microtech 60mm clip

muscle layer inversion

stomach insufflation management