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Endoscopic string clip suturing method: a prospective pilot study (with video).

Toshihiro Nishizawa¹, Teppei Akimoto², Toshio Uraoka³

¹Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.

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|November 21, 2017

Summary

A novel string and clip suturing technique effectively closes large mucosal defects after duodenal endoscopic submucosal dissection (ESD). This method offers a safe and efficient approach, reducing patient hospital stays.

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Area of Science:

Gastroenterology
Endoscopic Surgery
Surgical Innovation

Background:

Endoscopic submucosal dissection (ESD) for duodenal tumors can result in large mucosal defects.
Closure of these defects is crucial to prevent complications and reduce recovery time.

Purpose of the Study:

To evaluate the feasibility and efficacy of a new string and clip suturing method for closing large mucosal defects after duodenal ESD.
To compare outcomes of the string clip suturing method with no closure after duodenal ESD.

Main Methods:

A prospective pilot study involving 10 patients undergoing duodenal ESD for tumors.
A novel technique using polyester string and clips passed through a single-channel endoscope to close mucosal defects.
Comparison with a historical cohort of 10 patients who did not have mucosal closure.

Main Results:

The string clip suturing method achieved a 100% success rate in closing large mucosal defects (mean size 39.1 mm).
The mean procedure time was 23.4 minutes, and one perforation during ESD was successfully managed with this method.
Patients treated with the string clip method had a significantly shorter length of hospital stay compared to the no-suture group.

Conclusions:

The string clip suturing method is a safe and effective technique for the endoscopic closure of large mucosal defects.
This innovative approach may improve patient outcomes and reduce healthcare resource utilization after duodenal ESD.