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DOI: 10.1055/a-2304-8184
Endoscopic hand suturing of small intestine and colon: complete suturing of a post-endoscopic submucosal dissection mucosal defect at the anastomosis after right hemicolectomy
Endoscopic hand suturing (EHS) was first reported by Goto et al. [1]. Although still in its infancy, it is expected to prevent complications, such as postoperative bleeding and perforation; however, due to the complexity of the procedure and the need to carry the needle to the target ulcer, it is currently used only in the distal colon and stomach [2] [3]. Herein, we report the use of EHS at the anastomotic site after right hemicolectomy.
A 79-year-old man was referred to our hospital because of a nongranular-type laterally spreading tumor that had been noted at the postoperative anastomosis after right hemicolectomy ([Fig. 1] a, b). We performed endoscopic submucosal dissection under texture and color enhancement imaging (TXI) and magnification using a GIF-XZ1200, with en bloc resection achieved in 88 minutes ([Fig. 1] c, d). The mucosal defect was semicircumferential, with half of the defect occupying the small-intestinal side.
Because the patient had diabetes mellitus and was taking antithrombotic medication, we needed to perform EHS, which is a secure and firm wound-closure method, using a wound-closure device (SutuArt, Olympus, Tokyo, Japan) and barbed suture (V-Lock, Medtronic, USA), to prevent postoperative bleeding and perforation ([Fig. 2]). The needle was delivered through an overtube, grasping the tail of the needle with the wound-closure device, with the needle tip positioned inside the hood. Technically, complete closure was achieved, and no adverse events were reported ([Fig. 3], [Video 1]). No evidence of wound dehiscence was observed at follow-up endoscopy the following day ([Fig. 4]). The patient was able to resume eating the day after treatment and was discharged home on the second postoperative day, without experiencing any complications.
Quality:
This is the first report of EHS of a mucosal defect at the postoperative anastomosis of the small intestine and colon. EHS could be added to the range of existing closure methods for mucosal defects at a postoperative anastomosis.
Endoscopy_UCTN_Code_TTT_1AO_2AO
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Publication History
Article published online:
05 June 2024
© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
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References
- 1 Goto O, Sasaki M, Akimoto T. et al. Endoscopic hand-suturing for defect closure after gastric endoscopic submucosal dissection: a pilot study in animals and in humans. Endoscopy 2017; 49: 792-797
- 2 Akimoto T, Goto O, Sasaki M. et al. Endoscopic hand suturing for mucosal defect closure after gastric endoscopic submucosal dissection may reduce the risk of postoperative bleeding in patients receiving antithrombotic therapy. Dig Endosc 2022; 34: 123-132
- 3 Abe S, Saito Y, Tanaka Y. et al. A novel endoscopic hand-suturing technique for defect closure after colorectal endoscopic submucosal dissection: a pilot study. Endoscopy 2020; 52: 780-785