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

Area of Science:

• Gastroenterology
• Surgical Innovation
• Endoscopic Procedures

Background:

• Colorectal endoscopic submucosal dissection (ESD) creates mucosal defects.
• Achieving sustained closure of these defects is crucial for patient outcomes.
• Endoscopic hand-suturing (EHS) is a novel technique explored for this purpose.

Purpose of the Study:

• To assess the feasibility of endoscopic hand-suturing (EHS) for colorectal defect closure post-ESD.
• To determine the attainability of sustained closure using EHS.
• To evaluate the rate of post-ESD bleeding associated with EHS.

Main Methods:

• Endoscopic hand-suturing (EHS) involved uninterrupted endoscopic suturing of mucosal defects after colorectal ESD.
• An absorbable barbed suture and a through-the-scope needle holder were utilized.
• Training was conducted on a porcine model, followed by application in human subjects with repeat colonoscopy for assessment.

Main Results:

• EHS was attempted on nine lesions, achieving a complete closure rate of 73%.
• Sustained closure was observed in 64% of cases, with a post-ESD bleeding rate of 9%.
• Median suturing time was 56 minutes, with a median of 8 stitches per lesion.

Conclusions:

• Endoscopic hand-suturing (EHS) demonstrated the ability to achieve complete and sustained closure of colorectal defects.
• The current procedure time for EHS is considered too long for widespread clinical applicability.
• Modifications to EHS techniques and instrumentation are recommended for future development.