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CC BY-NC-ND 4.0 · Endosc Int Open 2024; 12(10): E1150-E1159
DOI: 10.1055/a-2411-8724
Review

Endoscopic suturing for mucosal defect closure following endoscopic submucosal dissection: Systematic review and meta-analysis

Chengu Niu 
1   Internal Medicine, Rochester General Hospital, Rochester, United States (Ringgold ID: RIN6932)
,
Jing Zhang
2   Internal Medicine, Harbin Medical University, Harbin, China (Ringgold ID: RIN34707)
,
Umer Farooq
3   Gastroenterology Department, SLU, Saint Louis, United States (Ringgold ID: RIN7547)
,
Salman Zahid
4   Internal Medicine, Oregon Health & Science University, Portland, United States (Ringgold ID: RIN6684)
,
Patrick I Okolo
1   Internal Medicine, Rochester General Hospital, Rochester, United States (Ringgold ID: RIN6932)
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Abstract

Background and study aims: Endoscopic submucosal dissection (ESD) is a minimally invasive and effective treatment for gastrointestinal lesions. It carries potential risks such as bleeding and perforation. This meta-analysis was conducted to assess the safety, effectiveness, and feasibility of endoscopic suturing, a promising technique for closing mucosal defects post-ESD.

Methods: We reviewed several databases, including MEDLINE/PubMed, Cochrane Library, Web of Science, and Embase up to May 1,2023. We aimed at identifying original studies that provided insightful data on the use of endoscopic suturing in reducing complications post-ESD.

Results: In our study, we evaluated 426 publications and included 10 studies involving a total of 284 patients. The pooled technical success rate of endoscopic suturing was 92.6% (95% confidence interval [CI] 0.88–0.96). The pooled rate for sustained closure of mucosal defects post-endoscopic submucosal dissection (ESD) was estimated to be 80.7% (95% CI 0.71–0.88). The pooled mean time required to perform the endoscopic suturing procedure was calculated to be 31.11 minutes (95% CI 16.01–46.21). Among the studies reviewed for the incidence of delayed perforation post-ESD, a singular event of perforation was documented, suggesting a minimal occurrence. The overall rate of delayed bleeding was 5.3% (95% CI 0.30–0.10). Within the subset of patients using antithrombotic drugs, our subgroup analysis identified a delayed bleeding event rate of 6.7% (95% CI 0.02–0.25).

Conclusions: Our results underscore the potential of endoscopic suturing as a viable and efficient technique in managing mucosal defects following ESD, highlighting the need for further large, prospective research to corroborate these findings and concentrate on establishing standard methodologies.

Keywords

Endoscopy Upper GI Tract - Endoscopic resection (ESD, EMRc, ...) - Endoscopy Lower GI Tract - Endoscopic resection (polypectomy, ESD, EMRc, ...) - GI surgery

Supplementary Material



Publication History

Received: 30 August 2023

Accepted after revision: 04 September 2024

Accepted Manuscript online:
09 September 2024

Article published online:
10 October 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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