A Large Multicenter Experience With Endoscopic Suturing for Management of Gastrointestinal Defects and Stent Anchorage in 122 Patients

Sharaiha, Reem Z.; Kumta, Nikhil A.; DeFilippis, Ersilia M.; DiMaio, Christopher J.; Gonzalez, Susana; Gonda, Tamas A.; Rogart, Jason N.; Siddiqui, Ali; Berg, Paul S.; Samuels, Paul; Miller, Larry S.; Khashab, Mouen A.; Saxena, Payal; Gaidhane, Monica; Tyberg, Amy; Teixeira, Júlio; Widmer, Jessica L.; Kedia, Prashant; Loren, David E.; Kahaleh, Michel; Sethi, Amrita

doi:10.1097/mcg.0000000000000336

Cited by 111 publications

(61 citation statements)

References 16 publications

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“…The diverging poorer long-term (> 30 days) clinical success rate (26 %) may have been related to the location of the sutures and/or sewing technique performed. The rather small dimension of the leak in our specific case may have been advantageous as the diameter being one of the main predictor for a successful outcome [9,10]. Nevertheless, the GI defect of our patient appeared to be too wide for efficient clip placement.…”

Section: Discussionmentioning

confidence: 69%

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Endoscopic suturing as a less invasive approach for the treatment of anastomotic leakage after esophagogastrostomy – a case report

Schlosser

Feisthammel

Gockel³

et al. 2018

Z Gastroenterol

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Anastomotic leakage is a frequent complication after gastrointestinal (GI) surgery and is associated with high morbidity and mortality. Endoluminal therapy offers numerous advantages compared to surgical revision. We present the case of a 74-year-old female patient with anastomotic leakage after esophagogastrostomy. The defect was closed using the OverStitch endoscopic suturing system with immediate technical and clinical success. Hereby, an example of the feasibility of this novel technique in a case of anastomotic leakage is presented and provides an outlook for the rising importance of endoscopic therapy.

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Section: Discussionmentioning

confidence: 69%

“…Severe adverse events after endoluminal sewing are therefore rare and well manageable [10]. Moreover, endoscopic suturing usually leads to rather small scar tissue.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic suturing as a less invasive approach for the treatment of anastomotic leakage after esophagogastrostomy – a case report

Schlosser

Feisthammel

Gockel³

et al. 2018

Z Gastroenterol

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show abstract

“…Endoscopic suturing using Apollo Overstitch Suturing System (Apollo Endosurgery Inc., Austin, Texas, United States) is an attractive approach for leak closure if it is technically feasible. 19,20 The use of supplementary endotherapy should be determined by endoscopic appearance of leak, local expertise, and patient preference.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Management of Postlaparoscopic Sleeve Gastrectomy Leaks: A Single-Center Experience

Jagtap

Yashavanth

Kalapala

et al. 2020

Journal of Digestive Endoscopy

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Abstract Introduction Laparoscopic sleeve gastrectomy (LSG) is a commonly performed bariatric surgery. Sleeve leak is the most important complication, with an incidence of 1.9 to 2.4%. Various endoscopic approaches to LSG have been used, including self-expanding metal stents (SEMSs), glue injection, and clipping along with percutaneous drainage. This study was aimed to study the role of endotherapy in the management of post-LSG leaks. Methods This study included patients referred for endotherapy for post-LSG leak between January 2016 and December 2018. We maintained data prospectively, which included the location and type of leak, type of endotherapy, adverse events, and time for leak closure. Primary endotherapy included mega SEMS placement; if it failed, then secondary endoscopic therapy was performed. Results Seven patients (four females, with a mean age of 45.2 years) with a preoperative body mass index of mean 38.5 kg/m2 underwent endotherapy for post-LSG leaks. Two were acute, four were early, and the remaining one was late leak. Five were located proximally near gastroesophageal junction and two at the midsleeve level. In four (57.1%) patients, the leak was resolved by primary therapy. Three patients underwent secondary therapy that included overlapping SEMS placement (in one patient), SEMS replacement (in one patient), and short plastic biliary stent placement with Argon plasma coagulation (APC) to create a raw surface and induce granulation tissue. The median duration for leak closure was 12 weeks (range: 8–24 weeks). One patient who had partial distal migration underwent overlapping SEMS placement. Three patients had nonbleeding ulcers at the distal end of SEMS at removal. Conclusion Endotherapy is effective and safe for the management of post-LSG leaks. Additional endotherapy can be used if primary therapy is not successful for resolution of the leak.

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“…The OverStitch endoscopic suturing device (Apollo Endosurgery, Austin, Tex, USA) is currently the only device approved for clinical use to place running or interrupted sutures. Although current research heavily focuses on suturing for treatment of upper GI surgical complications and obesity treatment, some experience in the lower GI tract has been reported [65][66][67]. Multiple technical limitations have been noted, among which the need of a doublechannel endoscope, the need of an overtube and the lack of easy maneuverability [65].…”

Section: Suturing Devicesmentioning

confidence: 99%

Clips for managing perforation and bleeding after colorectal endoscopic mucosal resection

Turan

Ultee

Geenen

et al. 2019

Expert Review of Medical Devices

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Introduction: The most commonly used treatment for advanced colorectal adenomas is endoscopic mucosal resection (EMR). The increased number of EMRs since the introduction of the screening program for colorectal cancer has resulted in an increase in EMR-related complications. This review summarizes the current knowledge for the use of clips for the treatment and prevention of complications after EMR. Areas covered: The historical development of clips is summarized and their properties are evaluated. An overview is presented of the evidence for therapeutic and prophylactic clipping for bleeding or perforation after EMR in the colon. Several clipping techniques are discussed in relation to the efficacy of wound closure. Furthermore, new techniques that will likely influence the use of clips in the future endoscopic practice, such as endoscopic full-thickness resection (eFTR) are also highlighted. Expert commentary: Most research focuses on prophylactic clipping for delayed bleeding after EMR of large adenomas. We advocate a distance of 0.5-1.0 cm between aligning clips. This focus may likely shift from bleeding to perforation. Here, endoscopic treatment with through-the-scope clips and largediameter clips may well replace surgery. The future role of clips will also depend on the further development of new endoscopic technologies, such as eFTR.

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A Large Multicenter Experience With Endoscopic Suturing for Management of Gastrointestinal Defects and Stent Anchorage in 122 Patients

Cited by 111 publications

References 16 publications

Endoscopic suturing as a less invasive approach for the treatment of anastomotic leakage after esophagogastrostomy – a case report

Endoscopic suturing as a less invasive approach for the treatment of anastomotic leakage after esophagogastrostomy – a case report

Endoscopic Management of Postlaparoscopic Sleeve Gastrectomy Leaks: A Single-Center Experience

Clips for managing perforation and bleeding after colorectal endoscopic mucosal resection

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