Technical and clinical success of endoscopic hand-suturing: a European multicenter study

Endoscopic closure techniques are essential for management of endoscopic defects and help prevent delayed bleeding and perforation. This study reports clinical outcomes of an endoscopic hand-suturing system (EHS) for defect closure.

This multicenter European registry study evaluated all procedures using EHS from 14 centers. The primary end point was technical success, defined as complete defect closure without additional closure techniques. Secondary end points were in-hospital clinical success (absence of post-interventional complications), overall defect closure rate (closure achieved with additional devices), and suturing speed.

Between February 2023 and January 2026, 338 procedures were included. Indications comprised endoscopic submucosal dissection (n = 240), endoscopic intermuscular dissection (n = 32), gastric peroral endoscopic myotomy (n = 41), fistula (n = 10), endoscopic mucosal resection (n = 6), submucosal tunneling endoscopic resection (n = 3), nonexposed endoscopic wall inversion surgery (n = 2), and anastomotic leak, perforation, endoscopic full-thickness resection, and endoscopic hemostasis (all n = 1). Median defect size was 35 mm (range 4-155 mm) and median suturing time was 25 minutes (range 4-120). Technical success was 96.2% (325/338). Overall defect closure rate was 96.7% (327/338). In-hospital clinical success was 97.9% (331/338). Defect size did not predict suturing time in the size-adjusted model, indicating that procedural complexity was not explained by size alone. Procedure-related adverse events occurred in 5/338 (1.5%); overall adverse event rate was 10/338 (3.0%).

EHS demonstrated high technical and in-hospital clinical success with a low short-term adverse event rate. Further studies are needed to assess performance with complex defects.