A novel endoscopic hand-suturing technique for defect closure after colorectal endoscopic submucosal dissection: A pilot study

Seiichiro Abe, Yutaka Saito, Yusaku Tanaka, Mai Ego, Fumito Yanagisawa, Kazumasa Kawashima, Hiroyuki Takamaru, Masau Sekiguchi, Masayoshi Yamada, Taku Sakamoto, Takahisa Matsuda, Osamu Goto, Naohisa Yahagi

研究成果: Article査読

2 被引用数 (Scopus)

抄録

Background This study aimed to demonstrate the feasibility of endoscopic hand-suturing (EHS) and attainability of sustained closure after colorectal endoscopic submucosal dissection (ESD). Methods EHS was defined as uninterrupted endoscopic suturing of the mucosal defect after colorectal ESD using an absorbable barbed suture and a through-the-scope needle holder. Following individual EHS training using an ex vivo porcine colonic model, two experienced endoscopists performed EHS. Repeat colonoscopy was performed on the third or fourth day after ESD to examine the EHS site. The primary end point was the complete EHS closure rate, and secondary end points were sustained closure and post-ESD bleeding rates. Results 11 lesions were included. Median size of the mucosal defect was 38 mm (range 25-55 mm) and the lesion characteristics were as follows: Lower rectum/upper rectum/ascending colon/cecum = 3/3/2/3, and 0-IIa/0-Is + IIa/others = 5/4/2. EHS was not attempted in two patients owing to difficulty in colonoscope reinsertion after ESD and intraoperative perforation, respectively. EHS was performed for nine lesions, and the complete EHS closure rate was 73 %. Median procedure time for suturing was 56 minutes (range 30-120 minutes) and median number of stitches was 8 (range 6-12). Sustained closure and post-ESD bleeding rates were 64 % and 9 %, respectively. Conclusions EHS achieved complete and sustained closure in the colorectum. However, EHS is not currently clinically applicable given the long procedure time. Further modifications of the technique and devices are desirable.

本文言語English
ページ(範囲)780-785
ページ数6
ジャーナルEndoscopy
52
9
DOI
出版ステータスPublished - 2020 9 1

ASJC Scopus subject areas

  • Gastroenterology

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