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

Abstract

Background 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 until May1st 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 ten studies involving a total of 284 patients. The pooled technical success rate of endoscopic suturing was 92.6% (95% 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]). Conclusion 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.