ENDOSCOPIC CLIPS VERSUS ENDOSCOPIC SUTURE FOR MUCOSAL CLOSURE AFTER PER-ORAL ENDOSCOPIC PYLOROMYOTOMY: A PROSPECTIVE STUDY

Aims G-POEM is an emerging method for treatment of gastroparesis. Safe mucosal closure is necessary to avoid adverse events. The aim of this prospective study was to compare the effectivity of two closure methods: clips (Resolution^TM or Instinct^TM) and endoscopic suturing (ES, Apollo OverStitch^TM) in patients undergoing G-POEM.

Methods A single center, prospective study (NCT:03679104). All pts, who underwent G-POEM in our centre and agreed to participate were enrolled. The closure method was assigned at the discretion of an endoscopist prior to the procedure. The main outcome was the proportion of subjects with successful closure. Unsuccessful closure was defined as a need for a rescue method, or a need for an additional intervention (e.g. in case of leak). Secondary outcomes were easiness of closure (measured by a visual analogue scale; 0 = impossible/10 = very easy, scored by endoscopist and nurse) and closure time.

Results A total of 25 patients [M:F/11:14; mean age, range: 49.2 (26-74)] have been included; 15 received ES and 10 clips (mean 6; range 5-19). All patients with ES had successful closure. One patient with clips needed a rescue method (KING closure with endoloop) and another patient needed additional clipping because of a leak on POD1. The remaining 8 patients (80%) had a successful closure with clips. Closure with clips was quicker (mean closure time 10.3 min (range 4-15) vs 14 (5-20); p=0.048). Endoscopist tended to assess closure with ES easier compared to clips (mean VAS for ES 7.4 (3-10) vs. 6.4 (3-10) for clips; p=0.25). A nurse assessed easines of both closure methods as comparable (p=0.68).

Conclusions Endoscopic suturing system may be more reliable than clipping for mucosal closure in patients undergoing G-POEM. Besides clips, centers performing G-POEM should have an alternative (rescue) closure method. (Supported by a grant from the Czech Ministry of Health 17-28797A).