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

Abstract 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

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Endoscopic hand suturing for mucosal defect closure after gastric endoscopic submucosal dissection in in vivo animal models and clinical cases

10.26226/morressier.57c5383bd462b80296c9c103 ◽

2016 ◽

Author(s):

Osamu Goto

Keyword(s):

Animal Models ◽

Endoscopic Submucosal Dissection ◽

Defect Closure ◽

Submucosal Dissection ◽

Mucosal Defect ◽

In Vivo Animal Models ◽

Clinical Cases

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A novel endoscopic hand-suturing technique for defect closure after colorectal endoscopic submucosal dissection: a pilot study

Endoscopy ◽

10.1055/a-1120-8533 ◽

2020 ◽

Vol 52 (09) ◽

pp. 780-785

Author(s):

Seiichiro Abe ◽

Yutaka Saito ◽

Yusaku Tanaka ◽

Mai Ego ◽

Fumito Yanagisawa ◽

...

Keyword(s):

Endoscopic Submucosal Dissection ◽

Ex Vivo ◽

Barbed Suture ◽

Procedure Time ◽

Closure Rate ◽

Needle Holder ◽

Lower Rectum ◽

Submucosal Dissection ◽

Mucosal Defect ◽

Colorectal Endoscopic Submucosal Dissection

Abstract Background 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 uninterrupted endoscopic suturing of the mucosal defect after colorectal ESD using an absorbable barbed suture and a through-the-scope needle holder. Following individual EHS training using an ex vivo porcine colonic model, two experienced endoscopists performed EHS. Repeat colonoscopy was performed on the third or fourth day after ESD to examine the EHS site. The primary end point was the complete EHS closure rate, and secondary end points were sustained closure and post-ESD bleeding rates. Results 11 lesions were included. Median size of the mucosal defect was 38 mm (range 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. EHS was not attempted in two patients owing to difficulty in colonoscope reinsertion after ESD and intraoperative perforation, respectively. EHS was performed for nine lesions, and the complete EHS closure rate was 73 %. Median procedure time for suturing was 56 minutes (range 30 – 120 minutes) and median number of stitches was 8 (range 6 – 12). Sustained closure and post-ESD bleeding rates were 64 % and 9 %, respectively. Conclusions EHS achieved complete and sustained closure in the colorectum. However, EHS is not currently clinically applicable given the long procedure time. Further modifications of the technique and devices are desirable.

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Efficacy of an over-the-scope clip for preventing adverse events after duodenal endoscopic submucosal dissection: a prospective interventional study

Endoscopy ◽

10.1055/s-0044-102255 ◽

2018 ◽

Vol 50 (05) ◽

pp. 487-496 ◽

Cited By ~ 25

Author(s):

Tomoaki Tashima ◽

Ken Ohata ◽

Eiji Sakai ◽

Yoshitsugu Misumi ◽

Maiko Takita ◽

...

Keyword(s):

Adverse Events ◽

Endoscopic Submucosal Dissection ◽

R0 Resection ◽

Defect Closure ◽

Submucosal Dissection ◽

Mucosal Defect ◽

Over The Scope Clip ◽

Delayed Perforation ◽

The Mean ◽

Severe Adverse Events

Abstract Background Duodenal endoscopic submucosal dissection (ESD) remains technically challenging, with a high risk of severe adverse events. Because exposure of the duodenal post-ESD mucosal defect to pancreatic juice and bile acid reportedly induces delayed perforation and bleeding, we examined whether defect closure using an over-the-scope clip (OTSC) system was useful for preventing postoperative adverse events. Methods From April 2016 to February 2017, a total of 50 consecutive patients with superficial non-ampullary duodenal epithelial tumors (SNADETs) larger than 10 mm, with no more than semi-circumferential spread, were prospectively enrolled in this study. All of the lesions were treated by experienced ESD operators and the post-ESD mucosal defect was closed using OTSCs. Results All of the SNADETs were completely removed by ESD, with an R0 resection rate of 88.0 %. The mean procedure and closure times were 67.3 ± 58.8 minutes and 9.8 ± 7.2 minutes, respectively. Although complete defect closure was achieved in 94.0 % of the patients (47/50), two patients required surgical conversion. Delayed perforation occurred in only one patient (2.1 %), who did not have successful closure of the defect, as misplacement of the OTSC exposed the muscle layer. Meanwhile, delayed bleeding occurred in three patients (6.3 %); however, the bleeding was easily controlled using endoscopic coagulation. The mean duration of postoperative hospitalization was 5.5 ± 7.2 days. Conclusions Prophylactic defect closure using OTSCs may be effective in reducing severe adverse events after duodenal ESD.

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Colorectal endoscopic submucosal dissection using the pocket-creation method with single clip traction: a feasibility study

Endoscopy International Open ◽

10.1055/a-1372-3740 ◽

2021 ◽

Vol 09 (05) ◽

pp. E653-E658

Author(s):

Tatsuma Nomura ◽

Yoshikazu Hayashi ◽

Takaaki Morikawa ◽

Masahiro Okada ◽

Hisashi Fukuda ◽

...

Keyword(s):

Endoscopic Submucosal Dissection ◽

Major Axis ◽

En Bloc Resection ◽

Bloc Resection ◽

Success Rates ◽

En Bloc ◽

Submucosal Dissection ◽

Mucosal Incision ◽

Axis Length ◽

Colorectal Endoscopic Submucosal Dissection

Abstract Background and study aims The pocket-creation method (PCM) facilitates dissection of the central part of a tumor. We previously developed the PCM with clip traction (PCM-CT) to facilitate opening the mucosal pocket, which otherwise could become cumbersome. In the present study, we aimed to examine the feasibility of PCM-CT for colorectal endoscopic submucosal dissection (ESD). Patients and methods PCM-CT was performed on 30 patients with early colorectal tumors from October 2019 to April 2020. PCM-CT allows efficient opening of the mucosal pocket by using the PCM to dissect the center of the lesion and then apply traction with a single clip after making a circumferential mucosal incision. Results The median specimen major axis length, ESD time, ESD speed, and en bloc resection rate were 48 mm, 84 minutes, 20 mm2/min, and 100 % (30/30), respectively. The success rates for the traction clip and median single-clip-traction time were 100 % (30/30) and 1.5 minutes, respectively. Conclusions Colorectal ESD using PCM-CT is a simple and promising method.

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Thread-assisted mucosal defect closure using the locking-clip technique after gastric endoscopic submucosal dissection

Endoscopy ◽

10.1055/a-0725-7754 ◽

2018 ◽

Vol 50 (12) ◽

pp. E342-E343 ◽

Cited By ~ 4

Author(s):

Tatsuma Nomura ◽

Akira Kamei ◽

Shinya Sugimoto ◽

Tetsuro Harada ◽

Jun Oyamda

Keyword(s):

Endoscopic Submucosal Dissection ◽

Defect Closure ◽

Submucosal Dissection ◽

Mucosal Defect

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Safety and Efficacy of Nonanesthesiologist-Administrated Propofol during Endoscopic Submucosal Dissection of Gastric Epithelial Tumors

Gastroenterology Research and Practice ◽

10.1155/2019/5937426 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Keiichiro Abe ◽

Keiichi Tominaga ◽

Akira Kanamori ◽

Tsunehiro Suzuki ◽

Hitoshi Kino ◽

...

Keyword(s):

Adverse Events ◽

Endoscopic Submucosal Dissection ◽

University Hospital ◽

Physical Status ◽

Safety And Efficacy ◽

Submucosal Dissection ◽

Epithelial Tumors ◽

Physical Status Classification ◽

Significant Difference ◽

Status Classification

Objective. There is no consensus regarding administration of propofol for performing endoscopic submucosal dissection (ESD) in patients with comorbidities. The aim of this study was to evaluate the safety and efficacy of propofol-induced sedation administered by nonanesthesiologists during ESD of gastric cancer in patients with comorbidities classified according to the American Society of Anesthesiologists (ASA) physical status. Methods. Five hundred and twenty-two patients who underwent ESD for gastric epithelial tumors under sedation by nonanesthesiologist-administrated propofol between April 2011 and October 2017 at Dokkyo Medical University Hospital were enrolled in this study. The patients were divided into 3 groups according to the ASA physical status classification. Hypotension, desaturation, and bradycardia were evaluated as the adverse events associated with propofol. The safety of sedation by nonanesthesiologist-administrated propofol was measured as the primary outcome. Results. The patients were classified according to the ASA physical status classification: 182 with no comorbidity (ASA 1), 273 with mild comorbidity (ASA 2), and 67 with severe comorbidity (ASA 3). The median age of the patients with ASA physical status of 2/3 was higher than the median age of those with ASA physical status of 1. There was no significant difference in tumor characteristics, total amount of propofol used, or ESD procedure time, among the 3 groups. Adverse events related to propofol in the 522 patients were as follows: hypotension (systolic blood pressure<90 mmHg) in 113 patients (21.6%), respiratory depression (SpO2<90%) in 265 patients (50.8%), and bradycardia (pulse rate<50 bpm) in 39 patients (7.47%). There was no significant difference in the incidences of adverse events among the 3 groups during induction, maintenance, or recovery. No severe adverse event was reported. ASA 3 patients had a significantly longer mean length of hospital stay (8 days for ASA 1, 9 days for ASA 2, and 9 days for ASA 3, P=0.003). However, the difference did not appear to be clinically significant. Conclusions. Sedation by nonanesthesiologist-administrated propofol during ESD is safe and effective, even for at-risk patients according to the ASA physical status classification.

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