A 37-year-old patient with clinical signs of gastroparesis underwent a gastric peroral
endoscopic pyloromyotomy (G-POEM) technique. After creating the submucosal tunnel
and sectioning the pylorus, it was necessary to suture the gastric mucosotomy. Generally,
this is done with standard endoscopic clips, but given that the gastric mucosa and
muscular mucosa are thicker than the esophageal mucosa, it is sometimes difficult
to close the mucosotomy, and in other cases early dehiscence of the closure has been
described, requiring a second endoscopic closure [1].
Recently, a new endoscopic suturing system has been introduced, consisting of a flexible
needle holder, which allows standard surgical needles to be manipulated to perform
continuous manual suturing ([Fig. 1]).
In our case ([Video 1]), after performing the standard G-POEM technique, endoscopic suturing was performed
manually to minimize the risk of dehiscence and facilitate the suturing technique.
A 3–0 barbed suture was used, as this type of suture does not require a knot to be
tied to secure it. With only three stiches ([Fig. 2]
a), we managed to completely close the mucosal incision; a final fourth stitch was
applied in the opposite direction and secured with a simple knot to complete the closure
([Fig. 2]
b).
Pyloromyotomy and posterior closure of the mucosotomy using the manual suture device.Video
1
Fig. 1 Suturing device with surgical needle.
Fig. 2
a Needle passing through both edges of the mucosotomy. b The final knot to secure closure.
This recently introduced endoscopic hand suturing method for closure of mucosal resection
defects can be used for the closure of mucosotomies in third space techniques. We
believe that the development of new suturing techniques, such as the one described
here, will facilitate and provide security to the closures of third space techniques
in more complex locations, such as in the presented case.
Endoscopy_UCTN_Code_TTT_1AO_2AO
E-Videos is an open access online section of the journal Endoscopy, reporting on interesting cases and new techniques in gastroenterological endoscopy.
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