A double-channel cap-assisted closure of a gastric defect after endoscopic submucosal dissection

Endoscopic submucosal dissection (ESD) has been widely accepted as a standard of care for early gastric cancer (EGC). However, post ESD bleeding is one of the adverse events after ESD procedure, particularly for patients with antithrombotic therapy. A 73-year-old male underwent ESD for EGC located on the anterior wall of upper gastric body. We closed the large mucosal defect after ESD because he was taking cilostazol (100 mg/day) for ischemic heart disease. Endoscopic closure of the mucosal defect was successfully performed with endoclips and two endoloops using a standard single accessory channel gastroscope with a double-channel cap-assisted. A second look endoscopy, 4 days after ESD, demonstrated sustained closure of the post ESD defect. He was discharged 7 days after ESD without post ESD bleeding. This method is technically useful for closure of large mucosal defects in difficult locations after gastric ESD.