A novel endoscopic purse-string suture technique, “loop 9”, for gastrointestinal defect closure: a pilot study

Abstract

Background This study aimed to assess the feasibility and efficacy of the novel loop 9 method of gastrointestinal (GI) defect closure.

Methods 20 patients underwent a GI procedure that required defect closure. Loop 9 can be delivered through a single instrument channel (3.2 mm) and released at the defect site. After it has been anchored by two clips positioned on opposite sides of the defect edge, the loop 9 is tightened by pulling the end of the suture intraluminally using biopsy forceps. Additional clips are placed to achieve complete closure. The primary outcome was complete closure rate. The secondary outcomes were closure time, sustained closure rate, and adverse events.

Results Complete closure was achieved in 100 % of cases. The mean size of the mucosal defects was 17.5 mm (range 10–55 mm). The median closure time was 14 minutes. The sustained closure rate was 90 %. No adverse events were noted.

Conclusions The loop 9 technique is feasible and effective in achieving complete and sustained closure of therapeutic endoscopy-related GI defects.

Publikationsverlauf

Eingereicht: 04. Dezember 2020

Angenommen: 19. Januar 2021

Accepted Manuscript online:
20. Januar 2021

Artikel online veröffentlicht:
16. März 2021

• References

• 1 Uraoka T, Parra-Blanco A, Yahagi N. Colorectal endoscopic submucosal dissection in Japan and Western countries. Dig Endosc 2012; 24: 80-83
• 2 Kalloo AN, Singh VK, Jagannath SB. et al. Flexible transgastric peritoneoscopy: a novel approach to diagnostic and therapeutic interventions in the peritoneal cavity. Gastrointest Endosc 2004; 60: 114-117
• 3 Inoue H, Minami H, Kobayashi Y. et al. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy 2010; 42: 265-271
• 4 Zhang QS, Han B, Xu JH. et al. Clip closure of defect after endoscopic resection in patients with larger colorectal tumors decreased the adverse events. Gastrointest Endosc 2015; 82: 904-909
• 5 Akimoto T, Goto O, Nishizawa T. et al. Endoscopic closure after intraluminal surgery. Dig Endosc 2017; 29: 547-558
• 6 Paspatis GA, Arvanitakis M, Dumonceau JM. et al. Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement – Update 2020. Endoscopy 2020; 52: 792-810
• 7 Matsuda T, Fujii T, Emura F. et al. Complete closure of a large defect after EMR of a lateral spreading colorectal tumor when using a two-channel colonoscope. Gastrointest Endosc 2004; 60: 836-838
• 8 Shi Q, Chen T, Zhong YS. et al. Complete closure of large gastric defects after endoscopic full-thickness resection, using endoloop and metallic clip interrupted suture. Endoscopy 2013; 45: 329-334
• 9 Zhang Y, Wang X, Xiong G. et al. Complete defect closure of gastric submucosal tumors with purse-string sutures. Surg Endosc 2014; 28: 1844-1851
• 10 Nishizawa T, Ochiai Y, Uraoka T. et al. Endoscopic slip-knot clip suturing method: prospective pilot study (with video). Gastrointest Endosc 2017; 85: 433-437
• 11 Nishizawa T, Akimoto T, Uraoka T. et al. Endoscopic string clip suturing method: a prospective pilot study (with video). Gastrointest Endosc 2018; 87: 1074-1078