Tissue apposition methods after endoscopic treatment

It is desirable to perform prophylactic clipping in patients who are at high risk for bleeding after endoscopic mucosal resection (EMR). Quick Clip Pro® (OLYMPUS), ZEOCLIP® (ZEON MEDICAL), and Resolution® (Boston Scientific Japan) offer precise rotation with open and close functionality for exact clip placement. A medium-sized mucosal defect can be closed with sequential clips as if zipping up. It is difficult to achieve complete closure of a large mucosal defect using only conventional clips. Several useful methods have been reported such as the "hold-Anddrag" closure technique, endoscopic purse-string suture, slip knot clip suturing method, string clip suturing method, "loop clip" closure technique, and mucosal incision method. Extensive endoscopic knowledge of suture methods is required to manage complications endoscopically.