Endoscopy 2017; 49(08): 792-797
DOI: 10.1055/s-0043-110668
Innovations and brief communications
© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic hand-suturing for defect closure after gastric endoscopic submucosal dissection: a pilot study in animals and in humans

Osamu Goto1, Motoki Sasaki1, Teppei Akimoto1, Yasutoshi Ochiai1, Yoshiyuki Kiguchi1, Yutaka Mitsunaga1, Ai Fujimoto1, Tadateru Maehata1, Toshihiro Nishizawa1, Hiroya Takeuchi2, Yuko Kitagawa2, Naohisa Yahagi1
  • 1Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University, School of Medicine, Tokyo, Japan
  • 2Department of Surgery, Keio University, School of Medicine, Tokyo, Japan
Further Information

Publication History

submitted 12 July 2016

accepted after revision 15 February 2017

Publication Date:
24 May 2017 (eFirst)


Background and study aims Mucosal suturing enables reliable and optimal defect closure after endoscopic treatments. We developed and investigated the feasibility of endoscopic hand-suturing (EHS) after gastric endoscopic submucosal dissection (ESD) in porcine in vivo models and in human clinical cases.

Patients and methods EHS involving continuous suturing of the mucosal layers using a through-the-scope needle-holder and absorbable barbed suture, was performed after gastric ESD in six live pigs and in eight consecutive patients. Success rates, adverse events, and suture maintenance were subsequently investigated.

Results EHS was successfully completed in all six pigs and eight patients (100 %) without severe adverse events. However, at 1 week postoperatively the suture closures had not been maintained in all six porcine cases and in the first four clinical cases. In the later four clinical cases, wider and tight suturing of the mucosal edges ensured that the defects remained closed until postoperative week 4.

Conclusion EHS is a feasible procedure that may facilitate secure and refined endoscopic surgeries. Mucosal closure in such cases can be maintained using firm suturing.

Clinical trial number: UMIN000017125