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. 2023;25(1):46-51.
doi: 10.1016/j.tige.2022.11.002. Epub 2022 Nov 12.

Closure of Mucosal Defects Using Endoscopic Suturing Following Endoscopic Submucosal Dissection: A Single-Center Experience

Osman Ali  1 , Andrew Canakis  1 , Yuting Huang  2 , Harsh Patel  2 , Madeline Alizadeh  1 , Raymond E Kim  1
Affiliations

Closure of Mucosal Defects Using Endoscopic Suturing Following Endoscopic Submucosal Dissection: A Single-Center Experience

Osman Ali et al. Tech Innov Gastrointest Endosc. 2023.

Abstract

Background and aims: Endoscopic submucosal dissection (ESD) is a therapeutic technique for en-bloc resection of both large (>20 mm) and smaller, complex gastrointestinal neoplasms. ESD has a higher success rate of en-bloc resection and a lower rate of local recurrence compared to endoscopic mucosal resection (EMR). Removal of lesions via ESD can leave large mucosal defects, raising unique challenges leading to adverse events. We aimed to determine clinical outcomes including delayed bleeding, perforation and hospitalization in patients undergoing endoscopic suturing following ESD.

Methods: Single-center retrospective study of a prospectively collected database of consecutive adult patients who underwent ESD with mucosal defect closure using endoscopic suturing. Primary outcomes were adverse events, specifically, delayed bleeding or perforation. Secondary outcomes included need for hospitalization and suturing complications.

Results: 55 patients (mean age: 67 years) were included with a mean lesion size of 27.4 mm ± 15. Defect closure occurred in the esophagus (6), gastroesophageal junction (2), stomach (30), cecum (2), sigmoid colon (2) and rectum (13). A mean of 1.8 ± 1.0 sutures were required for defect closure. Hospital admission rates were 14% (8/55) with an average length of stay 2 days (range: 1-3 days). Intra-procedure perforation occurred in two patients and both were successfully treated with endoscopic suturing. There was one case of delayed bleeding and no cases of delayed perforation or suturing complications.

Conclusion: The use of endoscopic suturing following ESD is a safe and clinically reliable method to close mucosal defects. This approach is associated with minimal adverse events and need for hospitalization. Larger studies are needed to further validate these findings.

Keywords: Closure; Endoscopic Submucosal Dissection; Perforation; Suturing.

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Conflict of interest statement

Conflict of interest statement: Raymond Kim is a consultant for Apollo Endosurgery, Medtronic, and Cook medical. All other authors have no potential conflicts (financial, professional, or personal) that are relevant to the content presented in this manuscript.

Figures

Figure 1.
Figure 1.
Endoscopic Submucosal Dissection with Endoscopic Suture Closure
Figure 2.
Figure 2.
Location of ESD lesion suturing.
See this image and copyright information in PMC

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