Continuous suturing with a stay suture after endoscopic full-thickness resection in an experimental study

 

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Endoscopic full-thickness resection, as an extension of endoscopic submucosal dissection, has been attracting much attention for the treatment of submucosal tumors [1]. An essential part of this technology is a reliable full-layer closure method. Although no commonly accepted technique exists to realize full closure [2], suturing methods, which have been considered difficult, have shown promising results recently [3]. We describe a new technique for reliably closing large perforations. Endoscopic manipulation has many limitations compared with surgical procedures where both hands are available; however, the development of a new suture needle for use with endoscopes can help to establish a suturing method similar to surgery. The suture needle is a double-ended needle with V-loc180 (VLOCL0604; Covidien, Mansfield, Massachusetts, USA) cut at 10 cm and joined at the cut ends ([Fig. 1]).

All of the procedures were performed endoscopically using an intestinal model (WetLab; Shiga, Japan) with a 4-cm diameter defect ([Fig. 2]). The needle holder for flexible endoscopes mimicked a previously reported type [4]. To begin, one needle was inserted from the outside to the inside of the intestine at the wound center, and the other needle was inserted in the same manner on the contralateral side. By pulling the threads toward each other, the wound edge was turned inward, which became a stay suture. The wound, now raised in the center, was immediately penetrated horizontally and sutured continuously. Half of the wound was sutured with one end of the thread ([Fig. 3]; [Video 1]). The needle tip did not exit the lumen during the entire process. We have named this procedure “endoscopic full-thickness continuous suturing with stay suture” (EFT–CSS).

Video 1 Closure of a full-thickness perforation of around 4 cm in diameter using the continuous suturing with stay-suture technique.

All five closures in this study were completed. The median procedure time was 29 minutes 18 seconds. All stitches reliably sutured the full layer ([Fig. 4]), and no gaps existed because of manual tension.

Endoscopy_UCTN_Code_TTT_1AT_2AF

Publication History

Article published online:
22 September 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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