Endoscopy 2019; 51(04): S65
DOI: 10.1055/s-0039-1681360
ESGE Days 2019 oral presentations
Friday, April 5, 2019 14:30 – 16:30: Video lower GI 1 South Hall 1A
Georg Thieme Verlag KG Stuttgart · New York

A PILOT STUDY OF NOVEL ENDOSCOPIC HAND-SUTURING FOR DEFECT CLOSURE AFTER COLORECTAL ENDOSCOPIC SUBMUCOSAL DISSECTION

S Abe
1   Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
,
Y Saito
1   Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
,
Y Tanaka
1   Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
,
M Ego
1   Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
,
F Yanagisawa
1   Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
,
K Kawashima
1   Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
,
H Takamaru
1   Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
,
M Sekiguchi
1   Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
,
M Yamada
1   Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
,
T Sakamoto
1   Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
,
T Matsuda
1   Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
,
O Goto
2   Department of Gastroenterology, Nihon Medical School, Graduate School of Medicine, Tokyo, Japan
,
N Yahagi
3   Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University, Tokyo, Japan
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

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Aims:

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 an uninterrupted endoscopic suturing of the mucosal defect after colorectal ESD using an absorbable barbed suture and a through-the-scope type needle-holder. Two experienced endoscopists performed EHS, and prior to this study they individually received EHS training in 10 mucosal defects using ex-vivo porcine colonic model. Second look colonoscopy was undertaken on the 3 or 4 days after ESD to observe the EHS site. Due to safety consideration, five patients with rectal neoplasm ≥20 mm were recruited for the first stage of the study. In the second stage, six more patients with colorectal neoplasm ≥20 mm in any location, inclusive of proximal colonic lesions, were enlisted.

Results:

A total of 11 lesions were included. Median size of the mucosa defect was 38 mm (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. One lesion in the cecum, and the other in the ascending colon were excluded from analysis because EHS was not attempted owing to difficulty in total colonoscopy after ESD and intraoperative perforation, respectively. EHS was performed for nine lesions, and complete closure was achieved in eight. Median procedure time for suturing was 56 min (30 – 120) and median number of stitches was 8 (6 – 12). Complete closure was maintained in all eight patients during second look endoscopy. Although delayed bleeding occurred in one patient in whom complete closure was not attainable, and another patient developed fever, they were successfully treated with endoscopic hemostasis and intravenous antibiotics respectively.

Conclusions:

EHS is a feasible procedure even in the proximal colon. It may facilitate safer and more refined colorectal ESD, allowing for the treatment to be executed in the outpatient setting.