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ease presented to our unit with a 1-day history of hematemesis. On admission, his blood pressure was 100/60mmHg and pulse rate 102 beats/minute. The initial hematocrit was 29%. Urgent esophagogastroduodenoscopy (EGD) revealed a large esophageal tear at the cardia, measuring 15 × 10mm (●" Fig. 1). A diagnosis of Mallory–Weiss tear wasmade. Placement of the clips seemed insufficient because of the large diameter and length of the tear. In order to bring together the edges of the tear, an endoloop (EndoLoop MAJ 254; Olympus, Tokyo, Japan) was inserted in the esophagus by the endoscope (Olympus EVIS EXERA II GIFH180) in a freehand manner. After the endoloop snare was correctly placed around the tear, the snare was anchoredwith four clips (Quickclip; Olympus) at the margins of the tear (●" Fig. 2a). The loop was then tightened to close the defect (●" Fig. 2b). The clinical course of the patient was uneventful, and followup EGD performed 4 weeks later revealed complete healing of the tear with formation of scar tissue (●" Fig. 3). Application of clips and an endoloop in the esophagus has beendescribed as amethod for closure of large mucosal defects after endoscopic mucosal resection [1], and of esophagomediastinal fistulas [2]. The closure was completed with a single-channel endoscope in a sequential two-step maneuver: first, clips were deployed at the margins of the defect, followed by looping and tightening of the clips with the endoloop. A total of three patients were reported, with a 100% technical success. In our case, the esophagus served as a secondworking channel, allowing us to apply both accessories simultaneously with a favorable outcome. Further studies will be required to prove the feasibility of this approach.

The esophagus as a working channel: successful closure of a large Mallory–Weiss tear with clips and an endoloop