Endoscopic hand-suturing for defect closure after gastric endoscopic submucosal dissection: a pilot study in animals and in humans

Goto, Osamu; Sasaki, Motoki; Akimoto, Teppei; Ochiai, Yasutoshi; Kiguchi, Yoshiyuki; Mitsunaga, Yutaka; Fujimoto, Ai; Maehata, Tadateru; Nishizawa, Toshihiro; Takeuchi, Hiroya; Kitagawa, Yuko; Yahagi, Naohisa

doi:10.1055/s-0043-110668

Cited by 58 publications

(51 citation statements)

References 17 publications

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“…The unsustained closure occurred possibly because of insufficient tightening of the suture due to difficult needle manipulation in retroflexion, and poor approximation of the defect edges near the anal verge given the surrounding connective tissue outside the rectal lumen. Second, we used a single-channel colonoscope during EHS of the colorectum even in the distal colon, whereas a double-channel gastroscope was used in the stomach in the Goto study [19]. Needle grasping and releasing were easier when both accessory channels were utilized.…”

Section: Discussionmentioning

confidence: 99%

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A novel endoscopic hand-suturing technique for defect closure after colorectal endoscopic submucosal dissection: a pilot study

et al. 2020

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Background This study aimed to demonstrate the feasibility of endoscopic hand-suturing (EHS) and attainability of sustained closure after colorectal endoscopic submucosal dissection (ESD). Methods EHS was defined as uninterrupted endoscopic suturing of the mucosal defect after colorectal ESD using an absorbable barbed suture and a through-the-scope needle holder. Following individual EHS training using an ex vivo porcine colonic model, two experienced endoscopists performed EHS. Repeat colonoscopy was performed on the third or fourth day after ESD to examine the EHS site. The primary end point was the complete EHS closure rate, and secondary end points were sustained closure and post-ESD bleeding rates. Results 11 lesions were included. Median size of the mucosal defect was 38 mm (range 25 – 55 mm) and the lesion characteristics were as follows: lower rectum/upper rectum/ascending colon/cecum = 3/3/2/3, and 0-IIa/0-Is + IIa/others = 5/4/2. EHS was not attempted in two patients owing to difficulty in colonoscope reinsertion after ESD and intraoperative perforation, respectively. EHS was performed for nine lesions, and the complete EHS closure rate was 73 %. Median procedure time for suturing was 56 minutes (range 30 – 120 minutes) and median number of stitches was 8 (range 6 – 12). Sustained closure and post-ESD bleeding rates were 64 % and 9 %, respectively. Conclusions EHS achieved complete and sustained closure in the colorectum. However, EHS is not currently clinically applicable given the long procedure time. Further modifications of the technique and devices are desirable.

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Section: Discussionmentioning

confidence: 99%

“…Recently, Goto et al developed endoscopic hand-suturing (EHS) to close large mucosal defects after ESD. A former pilot study demonstrated technical feasibility and sustained closure of mucosal defects after gastric ESD [19]. However, there are no data regarding the clinical use of EHS for defect closure after colorectal ESD.…”

Section: Introductionmentioning

confidence: 99%

A novel endoscopic hand-suturing technique for defect closure after colorectal endoscopic submucosal dissection: a pilot study

et al. 2020

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“…showed that endoclip closure of post‐ESD ulcer significantly reduced delayed bleeding rate compared to the control group (3.3% vs 13.3%, P = 0.04). There were small case series suggesting the usefulness of endoscopic closure of the post‐ESD ulcer using endoclip‐and‐loop, OTSC device, overstitch suturing, or hand‐sewn suturing, although they were not comparative studies.…”

Section: Adverse Events Related To Gastric Esdmentioning

confidence: 99%

Management of adverse events related to endoscopic resection of upper gastrointestinal neoplasms: Review of the literature and recommendations from experts

Yamamoto

Kikuchi

Nagami

et al. 2019

Digestive Endoscopy

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Prevention therapy is recommended for lesions >1/2 of the esophageal circumference. Locoregional steroid injection is recommended for lesions >1/2–3/4 of the esophageal circumference and oral steroids are recommended for lesions >1/2 of the subtotal circumference. For lesions of the entire circumference, oral steroid combined with injection steroid is considered. Endoscopic balloon dilatation (EBD) is the first choice of treatment for stricture after esophageal endoscopic submucosal dissection (ESD). Radical incision and cutting or self‐expandable metallic stent can be considered for refractory stricture after EBD. In case of intraoperative perforation during esophageal ESD, endoscopic clip closure should be initially attempted. Surgery is considered for treatment of delayed perforation. Current standard practice for prevention of delayed bleeding after gastric ESD includes prophylactic coagulation of vessels on post‐ESD ulcers and giving proton pump inhibitors. Chronic kidney disease stage 4 or 5, multiple antithrombotic drug use, anticoagulant use, and heparin bridging therapy are high‐risk factors for delayed bleeding after gastric ESD. Intraoperative perforation during gastric ESD is initially managed by endoscopic clip closure. If endoscopic clip closure is difficult, other methods such as over‐the‐scope clip (OTSC), polyglycolic acid (PGA) sheet shielding etc. are attempted. Delayed perforation usually requires surgical intervention, but endoscopic closure by OTSC or PGA sheet may be considered. Resection of three‐quarters of the circumference is a risk factor for stenosis after gastric ESD. Giving prophylactic local steroid injection and/or oral steroid is reported, but effectiveness has not been fully verified as has been done for esophageal stricture. The main management method for gastric stenosis is EBD but it may cause perforation.

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“…EHS was performed using a GIF-Y0080 3D scope (Olympus) equipped with a prototype flexible needle holder (Olympus) and 15-cm, 3-0 absorbable barbed V-Loc 180 (VLOCL0604) sutures (Covidien, Mansfield, MA, USA), as described elsewhere. 1,2 Briefly, a needle with a knot at the tail was inserted from the markings on the right row and pulled out from the markings on the left row (Supplementary video 1), and the sutures were placed continuously and linearly from the distal to the proximal side (Fig. 1B).…”

Section: Endoscopic Hand Suturing Settings and Proceduresmentioning

confidence: 99%

“…Endoscopic hand suturing (EHS) is a novel suturing method that allows optimal and secure intraluminal suturing. 1,2 In EHS for mucosal defects, the mucosal rim of the defect is continuously and linearly sutured using a transorally delivered needle and suture. Although EHS is expected to be a promising technique for the development of various advanced therapeutic endoscopies, it requires advanced technical skills and significant experience in puncturing the mucosa using the needle, optimally grasping the needle, and tightening the thread using a flexible endoscope; therefore, how to efficiently obtain these necessary skills is an issue to be addressed.…”

Section: Introductionmentioning

confidence: 99%

Three-Dimensional Flexible Endoscopy Can Facilitate Efficient and Reliable Endoscopic Hand Suturing: An ex-vivo Study

et al. 2020

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Background/Aims: Three-dimensional (3D) flexible endoscopy, a new imaging modality that provides a stereoscopic view, can facilitate endoscopic hand suturing (EHS), a novel intraluminal suturing technique. This ex-vivo pilot study evaluated the usefulness of 3D endoscopy in EHS. Methods: Four endoscopists (two certified, two non-certified) performed EHS in six sessions on a soft resin pad. Each session involved five stitches, under alternating 3D and two-dimensional (2D) conditions. Suturing time (sec/session), changes in suturing time, and accuracy of suturing were compared between 2D and 3D conditions. Results: The mean suturing time was shorter in 3D than in 2D (9.8±3.4 min/session vs. 11.2±5.1 min/session) conditions and EHS was completed faster in 3D conditions, particularly by non-certified endoscopists. The suturing speed increased as the 3D sessions progressed. Error rates (failure to grasp the needle, failure to thread the needle, and puncture retrial) in the 3D condition were lower than those in the 2D condition, whereas there was no apparent difference in deviation distance. Conclusions: 3D endoscopy may contribute to increasing the speed and accuracy of EHS in a short time period. Stereoscopic viewing during 3D endoscopy may help in efficient skill acquisition for EHS, particularly among novice endoscopists. Clin Endosc 2020;53:334-338

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Endoscopic hand-suturing for defect closure after gastric endoscopic submucosal dissection: a pilot study in animals and in humans

Cited by 58 publications

References 17 publications

A novel endoscopic hand-suturing technique for defect closure after colorectal endoscopic submucosal dissection: a pilot study

A novel endoscopic hand-suturing technique for defect closure after colorectal endoscopic submucosal dissection: a pilot study

Management of adverse events related to endoscopic resection of upper gastrointestinal neoplasms: Review of the literature and recommendations from experts

Three-Dimensional Flexible Endoscopy Can Facilitate Efficient and Reliable Endoscopic Hand Suturing: An ex-vivo Study

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