Endoscopic full-thickness defect closure using a novel suture anchor device: a pilot survival porcine study

For gastric submucosal tumors originating from the muscularis propria, endoscopic full-thickness resection (EFTR) represents a safe and effective super minimally invasive surgery, in which secure defect closure is paramount [1]. Despite widespread adoption for closing post-EFTR transmural defects, through-the-scope clips and endoloop techniques remain inadequate for reliable full-thickness closure owing to superficial tissue grasp [2].

To address this limitation, a novel endoscopic suture anchor device ([Fig. 1]) that enables screwing into tissues was developed. Previously validated for mucosal defect closure after endoscopic submucosal dissection [3] [4], this device was evaluated for the first time in an in vivo porcine model for closing post-EFTR defects.

Fig. 1 Endoscopic suture anchor device (Micro-Tech, Nanjing, China).

A 2.5 × 1.5-cm “active perforation” was created in the anterior gastric body of a porcine model to simulate a post-EFTR transmural defect. Subsequently, the suture anchor devices were employed to close the defect using the following steps ([Video 1]).

Endoscopic suture anchor closure of gastric transmural defect in porcine model.Video 1

Six suture anchors pre-threaded with a nylon suture were deployed sequentially via the endoscopic working channel (GIF-Q260J; Olympus Medical Systems Corp., Tokyo, Japan). Anchors were alternately implanted along opposing full-thickness defect margins. Each anchor was secured by rotating the handle for tissue penetration, followed by depression for release. Following anchor placement in a zigzag pattern across the defect, suture tension was progressively optimized. Traction prompted complete edge approximation, followed by fixation and suture transection using a cinching device, ultimately achieving defect closure ([Fig. 2]). On postoperative day 1, complete blood count revealed no evidence of delayed hemorrhage. Surveillance endoscopy at one week showed no delayed perforation or bleeding. The six-week endoscopic follow-up revealed the suture anchors retained in situ (partial extrusion) with complete mucosal healing confirmed by biopsy forceps removal ([Fig. 3]).

Fig. 2 Endoscopic closure of a transmural defect after endoscopic full-thickness resection (EFTR) using novel suture anchors. a A simulated post-EFTR transmural defect. b Suture-loaded anchor placed 5–10 mm from defect margin. c Suture anchors positioned in zigzag pattern. d Cinching device advanced with suture. e Complete edge approximation preceding suture transection. f Closure integrity was verified by gastric insufflation-induced distension.

Fig. 3 Endoscopic follow-up at postoperative six weeks. a Suture anchors retained in situ (partial extrusion). b Healing confirmed by forceps removal.

By avoiding superficial grabbing, this suture anchor device facilitates effective closure of full-thickness defects, potentially reducing limitations imposed by defect size. Further studies are required to systematically evaluate its efficacy and safety.

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Conflict of Interest

Jiancong Feng, Yaqi Zhai, and Enqiang Linghu are inventors on a patent for the device described in this study. Zhenyu Liu declares no competing interests.

Acknowledgement

The authors gratefully acknowledge all healthcare professionals who contributed to this study.

• References

• 1 Linghu E. A new stage of surgical treatment: super minimally invasive surgery. Chin Med J 2022; 135: 1-3
• 2 Granata A, Martino A, Ligresti D. et al. Closure techniques in exposed endoscopic full-thickness resection: Overview and future perspectives in the endoscopic suturing era. World J Gastrointest Surg 2021; 13: 645-654
• 3 Feng J, Zhai Y, Liu Z. et al. A novel endoscopic suture anchor device for large mucosal defect closure in an in vivo porcine model. Endoscopy 2025; 57: E839-E840
• 4 Feng J, Zhai Y, Liu Z. et al. Novel endoscopic suture anchor device for large defect closure following endoscopic submucosal dissection. Turk J Gastroenterol (in press)

Publication History

Article published online:
02 October 2025