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

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

doi:10.1055/s-0043-110668

Endoscopy, Table of Contents

Endoscopy 2017; 49(08): 792-797
DOI: 10.1055/s-0043-110668

Innovations and brief communications

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

Osamu Goto

¹Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University, School of Medicine, Tokyo, Japan

,

Motoki Sasaki

¹Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University, School of Medicine, Tokyo, Japan

,

Teppei Akimoto

¹Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University, School of Medicine, Tokyo, Japan

,

Yasutoshi Ochiai

¹Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University, School of Medicine, Tokyo, Japan

,

Yoshiyuki Kiguchi

¹Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University, School of Medicine, Tokyo, Japan

,

Yutaka Mitsunaga

¹Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University, School of Medicine, Tokyo, Japan

,

Ai Fujimoto

¹Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University, School of Medicine, Tokyo, Japan

,

Tadateru Maehata

¹Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University, School of Medicine, Tokyo, Japan

,

Toshihiro Nishizawa

¹Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University, School of Medicine, Tokyo, Japan

,

Hiroya Takeuchi

²Department of Surgery, Keio University, School of Medicine, Tokyo, Japan

,

Yuko Kitagawa

²Department of Surgery, Keio University, School of Medicine, Tokyo, Japan

,

Naohisa Yahagi

¹Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University, School of Medicine, Tokyo, Japan

› Author Affiliations

Abstract

Background and study aims Mucosal suturing enables reliable and optimal defect closure after endoscopic treatments. We developed and investigated the feasibility of endoscopic hand-suturing (EHS) after gastric endoscopic submucosal dissection (ESD) in porcine in vivo models and in human clinical cases.

Patients and methods EHS involving continuous suturing of the mucosal layers using a through-the-scope needle-holder and absorbable barbed suture, was performed after gastric ESD in six live pigs and in eight consecutive patients. Success rates, adverse events, and suture maintenance were subsequently investigated.

Results EHS was successfully completed in all six pigs and eight patients (100 %) without severe adverse events. However, at 1 week postoperatively the suture closures had not been maintained in all six porcine cases and in the first four clinical cases. In the later four clinical cases, wider and tight suturing of the mucosal edges ensured that the defects remained closed until postoperative week 4.

Conclusion EHS is a feasible procedure that may facilitate secure and refined endoscopic surgeries. Mucosal closure in such cases can be maintained using firm suturing.

Clinical trial number: UMIN000017125

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