Omental Patching and Purse-String Endosuture Closure after Endoscopic Full-Thickness Resection in Patients with Gastric Gastrointestinal Stromal Tumors

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract, primarily arising from the stomach. With the widespread utilization of and technical advancements in endoscopy, gastric GISTs are being increasingly detected at an early stage, enabling complete endoscopic resection. Endoscopic full-thickness resection (EFTR) is an advanced technique that has been recognized as a treatment tool for neoplasms in the digestive tract in selected patients. Although a number of methods are available, closing large iatrogenic defects after EFTR can be a concern in clinical practice. If this potential problem is appropriately solved, patients with gastric GISTs would be suitable candidates for resection utilizing this technique. To our knowledge, this is the first study to propose omental patching and purse-string endosuture closure following EFTR as a feasible endoscopic option in patients with gastric GISTs.

Closing the Gaps: Endoscopic Suturing for Large Submucosal and Full-Thickness Defects

This article is a systematic review of relevant literature on endoscopic suturing as a primary closure technique for large submucosal and full-thickness defects after endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), and endoscopic full-thickness resection (EFTR). A comprehensive literature search was conducted through 2016 by using PubMed, to find peer-reviewed original articles. The specific factors considered were the procedural indications and details, success rates, clinical outcomes including complications, and study limitations. Six original articles were included in the final review: two with non-human subjects and four with human subjects. The mean success rate of endoscopic suturing was 97.4% (100% for human subjects and 95.4% for non-human subjects). The procedural time ranged from 7 to 89 min. The average size and depth of lesions were 2.71 cm (3.74 cm [human] and 1.96 cm [non-human]) and 1.52 cm, respectively. The technique itself had no reported impact on mortality. In conclusion, endoscopic suturing is a minimally invasive technique for the primary closure of defects caused by EMR, ESD, and EFTR, with a high success and low complication rate.

Transoral endoscopic suturing for gastroesophageal reflux diseases / 中国微创外科杂志

Objective To evaluate the short-term effects and complications of transoral endoscopic suturing in the treatment of gastroesophageal reflux diseases (GERD). Methods Sixteen patients with GERD, confirmed by gastroscopy, upper gastrointestinal barium meal examination, and esophageal pH value examination, received gastroesophageal suturing by using an endoscopic suturing device (manufactured by Bard Co.). The site of suturing was 1cm below the dentation line, with a suture interval of 1.5cm and a knot interval of 2.0cm. Symptom severity scoring, esophageal 24-hour pH monitoring and the degree of esophagitis before and 1 month after the operation were compared respectively. Results A total of 42 sutures and 21 knots were made in the 16 cases. The mean operation time was 30 min. The sum of heartburn scores and regurgitation scores before the treatment were 39 (mean, 2.44) and 32 (mean, 2.0), and those after the treatment were 11 (mean, 0.68) and 10 (mean, 0.63), respectively, with statistical significances between preoperation and postoperation ( ? 2 =19.5 and 16.33; P