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. 2025 Jun 27;17(6):106069.
doi: 10.4240/wjgs.v17.i6.106069.

Comparison between interrupted closure technique and traditional closure technique in endoscopic full-thickness resection for treating gastric subepithelial lesions

Meng Zhang  1 , Jiao Liu  1 , Yun-Peng Dong  1   2 , Qian Zhao  1 , Mei-Ling Lin  1   3 , Teng-Jiao Gao  1 , Jia-Li Feng  1 , Yi-Fei Wang  1 , Yu-Fan Guo  1 , Zhen Wang  1 , Wen Jia  1 , Zhuo Yang  4
Affiliations

Comparison between interrupted closure technique and traditional closure technique in endoscopic full-thickness resection for treating gastric subepithelial lesions

Meng Zhang et al. World J Gastrointest Surg. .

Abstract

Background: Gastric subepithelial lesions (SELs) are elevated lesions originating from the muscularis mucosa, submucosa, or muscularis propria, and may also include extraluminal lesions. For small SELs (less than 5 cm), complete endoscopic excision is the preferred treatment. Endoscopic full-thickness resection (EFTR) has proven to be an effective approach.

Aim: To evaluate the efficacy of the interrupted closure technique compared to the traditional closure technique in EFTR for gastric SELs.

Methods: This single-center, prospective, randomized controlled trial was conducted at a tertiary hospital from September 2023 to September 2024. A total of 90 patients who underwent EFTR for gastric SELs were randomly allocated to either the interrupted closure group (n = 44) or the traditional closure group (n = 46).

Results: All patients had complete resection and wound closure without any severe postoperative complications. The incidence of intraoperative gas-related complications was significantly lower in the interrupted closure group than in the traditional closure group (2.27% vs 26.09%, P = 0.001), demonstrating interrupted closure technique can reduce the incidence of gas-related issues. Statistical analysis revealed that the incidence of postoperative infection was significantly lower in the experimental group than in the control group (15.91% vs 41.30%, P = 0.008). Additionally, the median duration of antibiotic use was lower in the experimental group (3.5 days vs 5 days, P = 0.013). Abdominal pain levels on postoperative days 1 and 4 were also lower in the experimental group compared to the control group (P < 0.001).

Conclusion: The interrupted closure technique in EFTR for treating gastric SELs is safe and effective, reducing the incidence of intraoperative gas complications and postoperative infections.

Keywords: Endoscopic full-thickness resection; Gas complication; Gastric subepithelial lesion; Interrupted closure; Postoperative infection.

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Conflict of interest statement

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Figures

Figure 1
Figure 1
Resection of gastric submucosal lesions by interrupted closure in endoscopic full-thickness resection. A: The gastric subepithelial lesion in the gastric body was initially detected by endoscopy; B: A full-thickness incision around two-thirds circumferential of the lesion; C: The metallic clips closure were performed at the proximal of the wound surface; D: The wound was completely sutured with metal clips.
Figure 2
Figure 2
Resection of gastric submucosal lesions by traditional closure in endoscopic full-thickness resection. A: The gastric subepithelial lesion in the gastric body was initially detected by endoscopy; B: The full-thickness incision around the lesion was performed; C: The gastric wall defect after the lesion resection; D: The wound was completely sutured with metallic clips.
See this image and copyright information in PMC

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