Endoscopy 2020; 52(09): 780-785
DOI: 10.1055/a-1120-8533
Original article

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

Seiichiro Abe
1  Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
,
Yutaka Saito
1  Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
,
Yusaku Tanaka
1  Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
,
Mai Ego
1  Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
,
Fumito Yanagisawa
1  Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
,
Kazumasa Kawashima
1  Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
,
Hiroyuki Takamaru
1  Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
,
Masau Sekiguchi
1  Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
2  Cancer Screening Center, National Cancer Center Hospital, Tokyo, Japan
,
Masayoshi Yamada
1  Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
,
Taku Sakamoto
1  Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
,
Takahisa Matsuda
1  Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
2  Cancer Screening Center, National Cancer Center Hospital, Tokyo, Japan
,
Osamu Goto
3  Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan
,
Naohisa Yahagi
4  Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University, Tokyo, Japan
› Author Affiliations
TRIAL REGISTRATION: Single-center pilot study, UMIN000031512 at http://www.umin.ac.jp

Abstract

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.



Publication History

Received: 07 November 2019

Accepted: 04 February 2020

Publication Date:
23 March 2020 (online)

© Georg Thieme Verlag KG
Stuttgart · New York