Endoscopic Suturing Research Articles

Endoscopic double line suture repair technique for repairing Iatrogenic dural tear: a technical case report.

Introducing a suture repair technology, endoscopic double line suture repair technique, for iatrogenic dural injury during Percutaneous Endoscopic Lumbar Discectomy (PELD) surgery. A patient with dural injury and cauda equina herniation during PELD surgery was treated with endoscopic double line suture repair technique. A patient with dural injury and cauda equina nerve herniation during PELD surgery was successfully treated using double-line suture technique. After the repair, no obvious cerebrospinal fluid leakage and cauda equina nerve re-herniation was seen. During the postoperative observation period, the wound healed well and there were no complications related to cerebrospinal leakage. During the follow-up period (1 year), the patient reported significant symptom relief and no complications. This novel dural repair technology is safe and effective and can be used to treat dural injuries during PELD surgery.

Anastomotic leakage following surgical resection in the upper gastrointestinal tract

Surgical resection is the consistent component of curative treatment strategies for primary malignant diseases of the stomach and the esophagus. The placement of anastomoses for the necessary reconstruction still accounts for substantial morbidity and in the case of afailure to rescue also for mortality, especially for esophagojejunostomy and esophagogastrostomy. The diagnostics of anastomotic leakage routinely involve computed tomography and endoscopy and timely performance appears to be essential. Endoscopy can simultaneously initiate the essential treatment step. Amajor reason for the improvement of postoperative outcomes after resection in the upper gastrointestinal tract in the last decades is the successful and mostly endoscopically performed management of anastomotic leakage, whereby different endoscopic treatment options are now available. Endoscopic vacuum therapy has become established as the standard, normally with an endoscopic vacuum sponge technique but is also now supplemented by acombination system of vacuum sponge and stent. Furthermore, afoil-coated multiple lumen nasogastric tube represents another available option, which can possibly especially be used as aprophylactic measure. The longest established endoscopic therapy option for anastomotic leaks, the endoluminal metal stent, has been replaced as the standard by the vacuum treatment but is still used in suitable situations. Additionally, there are endoscopic suture devices that are currently only used very occasionally. Surgical revision is always available as treatment escalation but is only recommended for very early occurrences and possibly technically related anastomotic leakage and in the case of failure of endoscopic treatment. This article describes and summarizes the diagnostics and treatment of anastomotic leakages after surgical procedures of the upper gastrointestinal tract.

Endoscopic purse-string suture and naso-jejunal tube feeding for duodenal cutaneous fistula and gastric cutaneous fistula.

The Endoscopic Purse-string Suture (EPSS) technique has gained attention for its potential in closing large defects following gastrointestinal procedures. However, its application in fistula closure is not as widely reported. This study aims to evaluate the safety and efficacy of EPSS and naso-jejunal tube feeding in the closure of duodenal cutaneous fistulas and gastric cutaneous fistulas. This single-center retrospective study, conducted from September 2020 to September 2023 at Tongji University in Shanghai, China, examined the outcomes of EPPS and nasojejunal feeding for patients with gastric and duodenal cutaneous fistulas (n = 10). Demographic data, fistula characteristics, procedure technique and outcomes were evaluated. In this study, the average size of a fistula opening was 7.9 ± 4.6mm. The operations took an average of 25.8 ± 5.6min. Patients typically needed naso-jejunal tube feeding for a median of 14.0days, with an interquartile range (IQR) of 7.7-19.0days. The median duration of hospital stay post-operation was 16.5days, with an IQR of 7.0-25.0days. Nine patients were successful in their initial fistula closure using the EPSS technique. The other patient underwent a second EPSS and, ultimately, all patients experienced complete healing and fully recovered. There were no major adverse events reported. EPSS and naso-jejunal tube feeding are a safe and effective treatment option for duodenal and gastric cutaneous fistulas. Larger, prospective studies are needed to validate these findings and establish the long-term safety and efficacy of this approach.

Innovative thin endoscopic combination surgery in upper gastrointestinal tract: A case of endoscopic submucosal dissection and endoscopic hand suturing for gastric tumor.

Innovative thin endoscopic combination surgery in upper gastrointestinal tract: A case of endoscopic submucosal dissection and endoscopic hand suturing for gastric tumor.

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

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.

S4063 Endoscopic Management of Post-Esophagectomy Leak Using Endoscopic Suturing and Stent Placement

S4063 Endoscopic Management of Post-Esophagectomy Leak Using Endoscopic Suturing and Stent Placement

S3191 Successful Closure of a Delayed Persistent Duodenal Perforation Using Endoscopic Suturing After Failed Surgical Intervention

S3191 Successful Closure of a Delayed Persistent Duodenal Perforation Using Endoscopic Suturing After Failed Surgical Intervention

S3988 Esophageal Perforation After Percutaneous Endoscopic Gastrostomy (PEG) Tube Placement: A Complication Treated Successfully With Endoscopic Stent and Suture

S3988 Esophageal Perforation After Percutaneous Endoscopic Gastrostomy (PEG) Tube Placement: A Complication Treated Successfully With Endoscopic Stent and Suture

S1587 Endoscopic Clipping vs Suturing for Mucosotomy Closure in E-POEM and G-POEM: A Systematic Review and Meta-Analysis

S1587 Endoscopic Clipping vs Suturing for Mucosotomy Closure in E-POEM and G-POEM: A Systematic Review and Meta-Analysis

Glottic widening procedures (GWPs) to avoid tracheostomy in infants’ bilateral vocal cord paralysis: A systematic review and meta-analysis

ObjectiveThis systematic review and meta-analysis evaluated the efficacy of various glottic widening procedures (GWPs) in avoiding tracheostomy in infants with bilateral vocal cord paralysis (BVCP). MethodsA systematic literature search was conducted in PubMed, Scopus, Web of Science, and Cochrane Library from inception to July 2023, without any timeframe limitations. Studies reporting GWPs (Endoscopic anterior-posterior cricoid split, Botox injection, suture lateralization, and other procedures including laser posterior cordotomy/arytenoidectomy) in infants with BVCP were included. Meta-analysis was performed to assess tracheostomy avoidance and secondary outcomes including voice, swallowing, and resolution of airway symptoms. ResultsThirteen studies with 100 patients were included. The mean age was 51.6 days. The etiology of BVCP was idiopathic (83 %), neurologic (10 %), and acquired (7 %). The GWP interventions were successful in 88 % of patients, with only 12 % requiring tracheostomy after surgery. The pooled proportion for avoiding tracheostomy was 0.88 (95 % CI 0.82–0.94) across interventions, with no significant differences between techniques. Among patients who avoided tracheostomy, 64 % had normal voice, 86 % tolerated oral feeding, 77 % had airway symptom resolution, and 70 % had recovery of vocal cord mobility. ConclusionGWPs prevent a majority of infants with BVCP from undergoing tracheostomy, without permanent alterations to laryngeal function. All interventions were comparable in efficacy. Further research with larger sample sizes is warranted.

A novel endoscopic suturing device: comparison with endoclips and hand-sewn techniques for gastrostomy closure in an ex vivo porcine model

A novel endoscopic suturing device: comparison with endoclips and hand-sewn techniques for gastrostomy closure in an ex vivo porcine model

Efficacy and safety of the over-the-scope endoscopic suturing device for closure of defects after endoscopic submucosal dissection: a systematic review and meta-analysis

Background and AimsEndoscopic submucosal dissection (ESD) is used for closure of gastrointestinal (GI) lesions following endoscopic resection techniques such as endoscopic mucosal resection. Generally, a large defect is left that can increase the risk of postprocedural bleeding or perforation, and has been managed by techniques such as endoscopic placement of clips to reapproximate the defect edges. An over the scope suturing system (OSS), Overstitch created by Apollo endosurgery, has been designed for similar utility in ESD closure. Its design intent aimed for full thickness closure and exchange of suture without endoscopic removal. This paper aims to evaluate the technical success and efficacy of use of OSS in the closure of ESD. MethodsA comprehensive literature review across multiple databases was performed. Studies including Overstitch and ESD information were evaluated, with 7 articles meeting predetermined eligibility of quality for inclusion. Statistical analysis was completed using CMV v 3.0 software. The primary evaluated endpoint was technical success and efficacy of instrument use in patients undergoing ESD closure with OSS. The secondary evaluated endpoint was the overall rate of adverse events related to the use of OSS. ResultsOverall, the pooled rates for instrumental efficacy and technical success were 95.8% (95% CI: 80.6%, 99.2%; P=0.04) and 99.2% (95% CI: 79.8%, 100.0%; P=1.00), respectively. The pooled rate of adverse events was 0.9% (95% CI: 0.0%, 24.8%; P=0.99) with pain reported as the most common adverse event. ConclusionsThe OSS system appears to be an effective and safe tool in the closure of defects after ESD. However, its design also makes it quite large and difficult to maneuver. While it allows for replacement of the suture kit without endoscopic removal, there have been multiple reported episodes of device failure. Further randomized controlled trials warranted as OSS becomes more widely used.

Preliminary validation of the virtual bariatric endoscopic simulator

Background and AimsObesity is a global health concern. Bariatric surgery offers reliably effective and durable weight loss and improvements of other comorbid conditions. However, the accessibility of bariatric surgery remains limited. Minimally invasive techniques, including endoscopic sleeve gastroplasty (ESG), have emerged to bridge this gap. To effectively complete the ESG procedure, one requires skill in multiple complex interventional endoscopic maneuvers. This requisite expertise poses challenges for training in this burgeoning field. MethodsWe designed the Virtual Bariatric Endoscopic (ViBE) simulator software to mimic the ESG procedure accurately. It features a detailed simulation of an endoscope equipped with an endoscopic suturing system and a high-resolution stomach, enhancing the visualization of the procedural details. Furthermore, it incorporates performance metrics utilizing a reverse scoring system to evaluate users’ proficiency in tasks such as argon plasma coagulation (APC) marking, suturing, and cinching. To validate the simulator, we conducted a study involving experts and novices at the Indiana University School of Medicine, where participants engaged with the simulation environment in a series of training tasks. ResultsTwelve participants, comprising five experts and seven novices, participated in the study. They were asked to complete a post-questionnaire featuring seven items, rating each on a Likert scale. The APC task realism received the highest score, averaging 3.83. The usefulness of improving endoscopic technical skills averaged 3.08, with the realism of cinching the knot and suturing tasks receiving scores of 3.17 and 3.25, respectively, suggesting a generally positive reception. Automated performance metrics indicated that, on average, experts outperformed novices by 10.83 points. ConclusionThe ViBE simulation strives to replicate the steps of the ESG within a virtual environment. Our primary objective in developing this simulator is to enhance the learning curve for endoscopic suturing and ESG techniques, thereby safely extending these skills to a broader patient base.

Application of endoscopic purse-string sutures in refractory nonvariceal GI bleeding: a multicenter study (with video)

Background and AimsNon-variceal gastrointestinal bleeding is a common medical emergency. Endoscopic hemostasis is recommended and some patients experienced rebleeding after conventional endoscopic hemostasis. Originally, the purse-string suture (PSS) was employed for lesion closure during endoscopic mucosal resection (EMR). We aimed to learn whether endoscopic PSS is effective in controlling the refractory bleeding. MethodsWe retrospectively collected data of patients who underwent endoscopic PSS for refractory non-variceal gastrointestinal bleeding from 3 hospitals. Clinical success was defined as no recurrent bleeding, and patients were discharged according to medical advice. ResultsFrom October 2017 to May 2024, 36 patients who received PSS treatments were included. 83.3% (30/36) of patients achieved clinical success. In refractory upper gastrointestinal bleeding, the clinical success rate was 81.25% (26/32), and it was 100% (4/4) in lower gastrointestinal bleeding. ConclusionThe endoscopic PSS is effective in treating refractory non-variceal gastrointestinal bleeding.

Automatic endoscopic gastroplasty for the treatment of obesity: results from a prospective multicenter study (with video)

EndoZip (Nitinotes Ltd, Cesarea, Israel) is a fully automated, operator-independent robotic endoscopic suturing device developed for gastric volume reduction and treatment of obesity. We aim to assess the efficacy and safety of EndoZip to treat patients with obesity. We conducted a prospective multicenter study and recruited 45 patients with a body mass index of 30 to 40 kg/m2. Our primary outcome was to assess the percentage of total body weight loss (%TBWL) at 12 months. The secondary outcome was to determine the safety and change in quality of life using the Influence of Weight on the Quality of Life questionnaire at 1 year. The mean ± standard deviation age was 44.2 ± 8.8 years, and the mean ± standard deviation body mass index was 34.5 ± 2.9 kg/m2. A majority (90.7%) of patients were female. The procedure was technically successful in all patients (100%). A median of 4 (range, 3-5) full-thickness sutures were placed, and the mean procedure time was 30.8 ± 15.8 minutes. At 12 months, the mean %TBWL was 13.21 (95% confidence interval, 10.11-16.31), and 76.6% of patients achieved≥5% TBWL. We observed significant reduction in waist circumference, glycated hemoglobin, and alanine aminotransferase levels at 12 months (P< .001). We found a significant improvement in quality of life at 12 months (51.28 ± 16.22 vs 35.8 ± 11.9, P< .001). Serious adverse events occurred in 2 patients (4.4%). The average length of stay was 1 day. Our first-in-human study showed that the EndoZip device is safe and effective in treating obesity. The weight loss led to changes in comorbidities and improvement in quality of life. (Clinical trial registration number: NCT04773795.).

Intraoperative Ultrasound in Endoscopic Sagittal Suture Synostosis to Optimize Incision Planning and Avoid Misdiagnosis.

Endoscopy-assisted craniectomy with lateral osteotomies and postoperative helmet molding therapy is a widely used approach in managing sagittal suture craniosynostosis. Generally, the incisions are placed just posterior to the anterior fontanel and just anterior to the posterior fontanel and lambdoid sutures, and accurate incision placement optimizes the safe separation of the superior sagittal sinus. The authors present their 10 year experience with an ultrasound-assisted approach to identify the lambdoid sutures and precisely place the skin incisions. The authors included all patients in care at their institution between 2010 and 2023 who operated for sagittal suture craniosynostosis with endoscopy-assisted craniectomy with lateral osteotomies and postoperative helmet molding therapy. A retrospective review of clinical parameters, surgical data, as well as outcomes, and imaging studies was performed. One hundred patients were operated during the observation period. The mean age was 3.9 ± 3.5 (range: 2.7-6.4) months. Intraoperative ultrasound was documented in 61% of cases (n = 61). In 100% of cases, the incisions were placed behind the anterior and in front of the posterior fontanel, as planned with ultrasound. In 2 additional cases, intraoperative sonography identified a patent sagittal suture in the operating room. A histopathological review showed suture ossification in 100% of operated cases with available reports. Using this technique of ultrasound-guided identification of the lambdoid suture/posterior fontanel, as well as coronal suture/anterior fontanel, may aid in the adequate placement of skin incisions. Patent sutures can be identified in clinically misdiagnosed patients. This study reaffirms the overall utility of ultrasound in pediatric operative neurosurgery.

Endoscopic hand suturing has the potential to reduce bleeding after gastric endoscopic submucosal dissection in patients on antithrombotic agents: Multicenter phase II study.

The risk of postoperative bleeding is high after gastric endoscopic submucosal dissection (ESD) in patients continuously treated with antithrombotic agents (ATAs). The effectiveness of endoscopic hand suturing (EHS) on bleeding after gastric ESD was investigated in patients at high risk of delayed bleeding. Patients with neoplasms ≤2 cm who underwent gastric ESD and continued to receive perioperative ATAs were enrolled in this multicenter phase II study. The mucosal defect was closed with EHS after removing the lesion. Postoperative bleeding rate was assessed for 3-4 postoperative weeks as a primary outcome measure. The technical success of EHS and adverse events were also assessed. Based on expected and threshold postoperative bleeding rates of 10% and 25%, respectively, we aimed to include 48 patients in the study. A total of 49 patients were enrolled in the study, and 43 patients were finally registered as the per-protocol set. The postoperative bleeding rate was 7.0% (3/43 patients; the upper limit of one-sided 95% confidence interval [CI], 17.1% and 97.5% CI, 19.1%). The upper limits of the CI were below the threshold value (25%), and the postoperative bleeding rate was below the expected value (10%). The technical EHS success rate, closure maintenance rate on postoperative day 3, and postoperative subclinical bleeding rate were 100%, 83%, and 2%, respectively. No severe adverse events related to EHS were observed. Endoscopic hand suturing may prevent postoperative bleeding in patients undergoing gastric ESD while being treated continuously with ATAs (UMIN000038140).

Long-term Results of Endoscopic Percutaneous Suture Lateralization for Newborns with Bilateral Vocal Cord Paralysis.

Bilateral vocal fold paralysis (BVFP) is a critical condition in newborns, which may present with significant airway distress necessitating tracheostomy. The purpose of this study is to report the safety and effectiveness of endoscopic percutaneous suture lateralization (EPSL) for newborns with BVFP, and evaluated the long-term results and the stability of the lateralization. A review of patients undergoing EPSL for BVFP at our institutions was performed between October 2018 and June 2023. Preoperative and postoperative clinical information was collected. The functional outcomes of the surgery in terms of breathing, voice, and swallowing were evaluated and recorded. Twenty seven patients were included, with a median age at diagnosis of 12 days (range, 1-33 days). The maximum follow-up is for 5 years. EPSL was successful in 77.8% of cases, effectively avoiding the need for tracheostomy. Dyspnea was relieved within a month after surgery, enabling patients to tolerate oral feeds within 2 months after surgery. Notably, some patients experienced a return of vocal fold function, particularly in successful EPSL cases, underlining the procedure's efficacy. Minor complications, including granulation tissue and wound infection, were observed but were manageable. Major complications were notably absent. The results are durable and stable at long-term follow-up. EPSL for BVFP is a relatively simple, minimally invasive, non-destructive, safe, and effective procedure in newborns, which may avoid the need for a tracheostomy, preserves the laryngeal framework, and does not affect the natural recovery of vocal cords. Level 3: retrospective case series Laryngoscope, 2024.

Feasibility of a novel unassisted single-channel transcolonic endoscopic appendectomy for the treatment of appendiceal lesions (with video).

Transcolonic endoscopic appendectomy (TEA) is rapidly evolving and has been reported as a minimally invasive alternative to appendectomy. We aimed to characterize the feasibility and safety of a novel unassisted single-channel TEA. We retrospectively investigated 23 patients with appendicitis or appendiceal lesions who underwent TEA from February 2016 to December 2022. We collected clinicopathological characteristics, procedure‑related parameters, and follow‑up data and analyzed the impact of previous abdominal surgery and traction technique. The mean age was 56.0years. Of the 23 patients with appendiceal lesions, fourteen patients underwent TEA and nine underwent traction-assisted TEA (T-TEA). Eight patients (34.8%) had previous abdominal surgery. The En bloc resection rate was 95.7%. The mean procedure duration was 91.1 ± 45.5min, and the mean wound closure time was 29.4 ± 18.6min. The wounds after endoscopic appendectomy were closed with clips (21.7%) or a combination of clip closure and endoloop reinforcement (78.3%), and the median number of clips was 7 (range, 3-15). Three patients (13.0%) experienced major adverse events, including two delayed perforations (laparoscopic surgery) and one infection (salvage endoscopic suture). During a median follow-up of 23months, no residual or recurrent lesions were observed, and no recurrence of abdominal pain occurred. There were no significant differences between TEA and T-TEA groups and between patients with and without abdominal surgery groups in each factor. Unassisted single-channel TEA for patients with appendiceal lesions has favorable short- and long-term outcomes. TEA can safely and effectively treat appendiceal disease in appropriately selected cases.

New Endoscopic Devices and Techniques for the Management of Post-Sleeve Gastrectomy Fistula and Gastric Band Migration.

Post-sleeve gastrectomy fistulas are a rare but possibly severe life-threatening complication. Besides early reoperation and drainage, endoscopy is the main treatment option. According to the clinical setting, endoscopic treatment options comprise stent or clip placement. New endoscopic therapies have recently gained attention, including endoscopic vacuum therapy, VacStent therapy, endoscopic internal drainage with pigtail stents, endoscopic suturing and stem cell injection. In this narrative review, we shed light on recent literature, developments, indications and contraindications of these treatments. Intragastric gastric band migration is a rare complication after gastric band positioning. Reoperation can sometimes be difficult, especially when a gastric band has already migrated far into the stomach. Endoscopic retrieval can be a valid, non-invasive therapeutic solution. We reviewed the current literature on this matter.