Endoscopic continuous suturing could enhance safety of endoscopic full-thickness resection in ex vivo porcine models

Endoscopic full-thickness resection (EFTR) is a minimally invasive technique for gastrointestinal tract resection and suturing; however, no standardized suturing method has been established. Here, we evaluated a novel endoscopic hand-suturing (EHS) technique, termed "endoscopic full-thickness continuous suturing with stay suture" (EFT-CSS), using SutuArt, an EHS needle holder. This method employs a double-ended needle with V-Loc™ 180 suture, enabling continuous full-thickness suturing. Three tests were conducted to compare EFT-CSS with existing methods: Tensile strength test-A 3-cm circular defect in porcine stomach specimens was closed using clip, purse-string suture (PSS), over-the-scope clip (OTSC), and EFT-CSS, each performed thrice. Maximum tensile strength was measured for each closure. Pressure test-A 3-cm circular defect in porcine stomach was closed using OTSC and EFT-CSS, each performed thrice. Air pressure was applied to the defect, and leakage was evaluated underwater. Safety test-A 3-cm circular defect in intestinal models was sutured on an aluminum plate using single- or double-ended needles, each performed thrice. Damage (scratches) on the aluminum plate and suturing time were recorded. EFT-CSS achieved the highest tensile strength (30.57 ± 8.90 N) compared with clip (3.69 ± 0.24 N), PSS (5.86 ± 0.32 N), and OTSC (19.93 ± 2.25 N). Leak pressure was significantly higher with EFT-CSS (54.67 ± 7.23 mmHg) versus OTSC (30.00 ± 5.00 mmHg). Scar area and suturing time were comparable, with reduced scarring observed when using double-ended needles. These results demonstrate that EFT-CSS outperforms conventional methods in strength and safety, offering a promising advancement in EFTR techniques.