EXPERIENCE AND UTILITY OF OVERSTITCH ENDOSCOPIC SUTURING SYSTEM IN A PUBLIC HOSPITAL

Aims:

The OverStitch™ Endoscopic Suturing System was approved by the FDA in 2008 to perform endoscopically transmural sutures and soft tissue approximation.

Nowadays its main use is in the field of private medicine for performing endoscopic bariatric therapies (most of them endoscopic sleeve gastroplasties).

Our aim is to evaluate the utility of the OverStitch™ in a public center where primary endoscopic bariatric therapies are not offered.

Methods:

We present a retrospective descriptive study about the experience of the OverStitch™ in a tertiary hospital, in the first year of its acquisition.

Patient characteristics, indications, technical success, clinical success and complications were analyzed.

Results:

• 12 patients were collected: 8 men and 4 women. The mean age was 56,6 years.

Tab. 1:

INDICATIONS AND RESULTS

INDICATION	CASES	TECHNIQUE	TECHNICAL SUCCESS	CLINICAL SUCCESS
Gastric bypass repair	7	Reducing stomal diameter +/- gastric pouch with continuous +/- interrupted sutures	Yes	Yes (75%, one case of weight reganance) ** 3 cases pending evolution
Esophageal stent fixation in benign pathology	3	Interrupted sutures	Yes	Yes
Ileocolonic anastomosis with fistulous orifice (after colonic neoplasm intervention)	1	Placement of fully covered enteral stent in ileocolonic anastomosis and closure of fistulous orifice with interrupted suture	Yes	Yes
Gastric bypass with choledocolithiasis, with casual finding of 2 gastrogastric fistulas	1	Fistula dilation + ERCP through fistula for reaching the excluded stomach, duodenum and duodenal papilla. Subsequent closure of fistulas with continuous sutures	Yes	No (reopening of the orifice was noticed after one year follow-up)

• All procedures were performed under general anesthesia with orotracheal intubation and no complications were registered.

• The duration of hospital admission was 24 hours after the procedure in most cases, except for the 3 esophageal stents (due to comorbidities not associated to the technique) and the closure of the ileocolonic anastomosis fistula.

Conclusions:

1. The OverStitch™ is a promising and useful technique.

2. It is a secure and effective technique, having obtained in our experience 78% of technical success, with no complications.

3. Despite the fact that its main use so far has been primary endoscopic bariatric therapies and repair of gastric bypass, there is a wide range of potential applications, as this technique may be used as well for closing fistula or gastrointestinal perforations and for stent fixation in benign diseases.