A novel endoscopic hand-suturing technique for defect closure after colorectal endoscopic submucosal dissection: a pilot study.
Endoscopy
; 52(9): 780-785, 2020 09.
Article
em En
| MEDLINE
| ID: mdl-32207119
BACKGROUND: This study aimed to demonstrate the feasibility of endoscopic hand-suturing (EHS) and attainability of sustained closure after colorectal endoscopic submucosal dissection (ESD). METHODS: EHS was defined as uninterrupted endoscopic suturing of the mucosal defect after colorectal ESD using an absorbable barbed suture and a through-the-scope needle holder. Following individual EHS training using an ex vivo porcine colonic model, two experienced endoscopists performed EHS.âRepeat colonoscopy was performed on the third or fourth day after ESD to examine the EHS site. The primary end point was the complete EHS closure rate, and secondary end points were sustained closure and post-ESD bleeding rates. RESULTS: 11 lesions were included. Median size of the mucosal defect was 38âmm (range 25â-â55âmm) and the lesion characteristics were as follows: lower rectum/upper rectum/ascending colon/cecumâ=â3/3/2/3, and 0-IIa/0-Isâ+âIIa/othersâ=â5/4/2. EHS was not attempted in two patients owing to difficulty in colonoscope reinsertion after ESD and intraoperative perforation, respectively. EHS was performed for nine lesions, and the complete EHS closure rate was 73â%. Median procedure time for suturing was 56 minutes (range 30â-â120 minutes) and median number of stitches was 8 (range 6â-â12). Sustained closure and post-ESD bleeding rates were 64â% and 9â%, respectively. CONCLUSIONS: EHS achieved complete and sustained closure in the colorectum. However, EHS is not currently clinically applicable given the long procedure time. Further modifications of the technique and devices are desirable.
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Base de dados:
MEDLINE
Assunto principal:
Neoplasias Colorretais
/
Ressecção Endoscópica de Mucosa
Idioma:
En
Ano de publicação:
2020
Tipo de documento:
Article