Suturing techniques with endoscopic clips and special devices after endoscopic resection

Area of Science:

• Gastroenterology
• Endoscopic Surgery
• Medical Device Technology

Background:

• Endoscopic submucosal dissection (ESD) is a key method for resecting early gastrointestinal tumors.
• Adverse events like bleeding and perforation can occur post-ER, with limited defined preventative methods.
• Endoscopic defect closure, primarily with clips, is standard but has limitations.

Purpose of the Study:

• To review and summarize current endoscopic defect closure techniques following endoscopic resection (ER).
• To highlight advancements in devices and methods for minimizing adverse events post-ER.
• To emphasize the need for simplified and promoted endoscopic closure strategies.

Main Methods:

• Review of existing endoscopic closure techniques, including various clip types (reopenable, large-teeth, over-the-scope).
• Discussion of alternative methods like clip-lines, rings with anchors, endoloops, and endoscopic ligation.
• Exploration of newer techniques adapted from full-thickness resection, utilizing curved needles, stitches, and endoscopic tack/suture devices.

Main Results:

• A range of endoscopic closure devices and techniques are available, from simple clips to complex suture systems.
• Over-the-scope clips and newer suturing devices offer enhanced defect closure capabilities.
• Existing methods are applied in various scenarios, including emergency endoscopy and fistula closure.

Conclusions:

• While endoscopic closure with clips shows high success, further simplification and promotion of techniques are needed.
• Optimizing defect closure is essential for reducing adverse events after endoscopic resection.
• Continued innovation in endoscopic closure devices and techniques is vital for patient safety.