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Published on: April 28, 2026
Endoscopic Hand Suturing After Gastric Endoscopic Submucosal Dissection in Patients with Low to Intermediate Risk of
Zofia Orzeszko1, Przemysław Kasprzyk2, Urszula Zawada2
1Department of Surgery, Faculty of Health Sciences, Jagiellonian University, Trynitarska 11 Street, 31-061, Krakow, Poland. zofia.orzeszko@uj.edu.pl.
Digestive Diseases and Sciences
|August 12, 2026
Summary
Endoscopic hand suturing (EHS) after gastric endoscopic submucosal dissection (ESD) is feasible for defect closure in Western patients. However, its clinical benefit for low-risk patients remains uncertain despite a zero delayed bleeding rate.
Area of Science:
- Gastroenterology
- Endoscopic Surgery
- Oncology
Background:
- Endoscopic hand suturing (EHS) is used for large mucosal defects post-gastric endoscopic submucosal dissection (ESD).
- Evidence for prophylactic EHS in low-to-intermediate risk delayed bleeding (DB) patients is limited.
- This study assesses EHS feasibility in a Western population.
Purpose of the Study:
- Evaluate the feasibility of endoscopic hand suturing (EHS) following gastric endoscopic submucosal dissection (ESD).
- Assess the efficacy of EHS in preventing delayed bleeding (DB) in low-to-intermediate risk patients.
- Determine the impact of EHS on procedure time and hospital stay.
Main Methods:
- Retrospective pilot study of 46 patients with low-to-intermediate DB risk (BEST-J score 0-2) undergoing gastric ESD.
- Patients were divided into EHS group (n=20) and no-closure group (n=26).
- Primary outcomes: technical success and DB rate. Secondary outcomes: overall procedure time (OPT), perforation, and hospital stay (HS).
Main Results:
- 100% technical success for en bloc resection and closure.
- Zero DB rate in the EHS group versus 7.7% in the no-closure group.
- EHS increased OPT (59 vs. 35 min) but reduced HS (2.1 vs. 2.9 days). No perforations occurred.
Conclusions:
- Endoscopic hand suturing (EHS) is a feasible technique for gastric defect closure post-ESD in a Western setting.
- EHS demonstrated a trend towards reduced delayed bleeding but increased procedure time and cost.
- The clinical benefit of prophylactic EHS in low-to-intermediate risk patients requires further investigation.