Comprehensive defect closure with overStitch Sx after endoscopic resection of gastric and duodenal subepithelial lesions

Abstract

Background and aims: Endoscopic suturing systems (ESS), OverStitch Sx, are promising tools for defect closure resulting from the endoscopic resection of gastric subepithelial lesions (SELs) with muscle involvement and duodenal SELs. Limited reports are available.

Methods: We retrospectively analyzed 12 defects intended to be closed with OverStitch Sx after the endoscopic resection of 8 gastric gastrointestinal stromal tumors (GISTs), 1 amyloidosis, 1 duodenal GIST, 1 paraganglioma, and 1 lipoma.

Results: The mean tumor size was 26.3 (15-50) mm. Most lesions were in anatomy challenging for endoscopic approach, and 75 % of the tumors required additional traction for complete resection. We achieved complete endoscopic resection in all cases and R0 resections in 83 %. The defects in which ESS were attempted consisted of 9 gastric muscle layers, 1 duodenal muscle layer, and 2 duodenal mucosal defects. ESS completely closed 4 (33.3 %) and partially closed 6 (50 %) defects, allowing clips to seal the defect. Among the 10 sutured defects, 6 required auxiliary techniques, such as adjusting the patient's position, abdominal compression, and marking to enhance the suturing areas. We failed to close 2 (16.7 %) defects using ESS and rescued with clips. The average hospital stay was 4.2 (2-7) days without major complications.

Conclusions: This series highlights the success of using ESS to treat defects caused by the endoscopic resection of SELs in the stomach and duodenum. Endoscopic resection and suturing are promising, and auxiliary techniques are required to facilitate defect closure.