Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 28, 2023; 29(4): 731-743
Published online Jan 28, 2023. doi: 10.3748/wjg.v29.i4.731
Feasibility and efficacy of endoscopic purse-string suture-assisted closure for mucosal defects induced by endoscopic manipulations
Ming-Ming Li, Yi Zhang, Fang Sun, Man-Xiu Huai, Fei-Yu Zhang, Chun-Ying Qu, Feng Shen, Zheng-Hong Li, Lei-Ming Xu
Ming-Ming Li, Yi Zhang, Fang Sun, Man-Xiu Huai, Fei-Yu Zhang, Chun-Ying Qu, Feng Shen, Zheng-Hong Li, Lei-Ming Xu, Department of Gastroenterology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
Author contributions: Li MM and Zhang Y contributed equally to this work; Li MM and Zhang Y drafted the manuscript and analyzed the data; Xu LM and Zhang Y designed the study and supervised its implementation; Xu LM, Zhang Y, Qu CY, and Shen F completed the endoscopic manipulations; Sun F, Huai MX, Zhang FY and Li ZH, participated in the experiments; and all authors made critical revisions and approved the final version to be published.
Supported by the National Natural Science Foundation of China, No. 82172737 and 82003277; and Shanghai Municipal Education Commission, No. 16411950403 and 19411951605.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee at Xinhua Hospital (approval number: XHEC-C-2018-109), Shanghai Jiaotong University School of Medicine.
Informed consent statement: Informed consent was obtained from all individual participants included in the study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at xuleiming@xinhuamed.com.cn. Participants gave informed consent for data sharing.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Lei-Ming Xu, MD, Chief Doctor, Professor, Department of Gastroenterology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, No. 1665 Kongjiang Road, Shanghai 200092, China. xuleiming@xinhuamed.com.cn
Received: October 16, 2022
Peer-review started: October 16, 2022
First decision: November 17, 2022
Revised: November 27, 2022
Accepted: January 9, 2023
Article in press: January 9, 2023
Published online: January 28, 2023
Processing time: 96 Days and 3.8 Hours
Abstract
BACKGROUND

Large or transmural defects induced by gastrointestinal endoscopic manipulations are difficult to close, although complete closure is recommended for better recovery. Endoscopic purse-string assisted suturing (EPSS) has been used in clinical practice and has proven to be an effective and safe technique for the closure of large mucosal defects. However, details regarding the efficacy of endoscopic pre-purse-string suture (P-EPSS) are unknown, especially that it offers several advantages over conventional EPSS (C-EPSS).

AIM

To elucidate the outcomes of EPSS-assisted closure in different clinical situations, and evaluate the efficacy of P-EPSS.

METHODS

This retrospective observational study included a total of 180 patients who underwent closure assisted by P-EPSS (n = 63) or C-EPSS (n = 117) between July 2014 and June 2020. The P-EPSS and C-EPSS groups were compared and the intergroup differences in aspects such as the lesion size, location, and mor-phology, incidence of complete closure, intraoperative perforation, and delayed adverse events were evaluated. Data on the features and clinical course of cases with adverse events were collected for further analysis.

RESULTS

Patients with lesion size larger than 3 cm, lesions located at the fundus of stomach, or submucosal tumors originating from the deep mucosa were more likely to undergo P-EPSS-assisted closure. The P-EPSS group showed a sign-ificantly higher proportion of intraoperative perforation (56% vs 17%) and a much shorter procedure time (9.06 ± 6.14 min vs 14.84 ± 7.25 min). Among adverse events, the incidence of delayed perforation (5% vs 4%; P = 0.82) and delayed bleeding (3% vs 4%; P = 0.96) did not differ significantly between the groups. Multivariate analysis revealed that lesions with incomplete closure [odds ratio (OR) = 21.33; 95% confidence interval (CI): 5.45-83.45; P < 0.01] or size greater than 3 cm (OR = 3.14; 95%CI: 1.08-9.18; P = 0.039) showed a statistical tendency to result in an increase in delayed adverse events.

CONCLUSION

The present study revealed that EPSS could achieve secure complete closure of mucosal defect. P-EPSS could shorten the procedure and yield complete closure of mucosal defects. Rather than closure-type selection, incomplete closure or lesion size larger than 3 cm were associated with worse outcomes.

Keywords: Endoscopic purse-string suture; Mucosal defect; Endoscopic full-thickness resection; Endoscopic submucosal dissection

Core Tip: Endoscopic purse-string assisted suturing (EPSS) has proven to be an effective and safe technique for the closure of large mucosal defects. Endoscopic pre-purse-string suture (P-EPSS) is recently introduced and offers several advantages over conventional endoscopic purse-string suture (C-EPSS). We found that the novel method could offer several advantages over C-EPSS. This retrospective observational study included a total of 180 patients who underwent P-EPSS (n = 63) or C-EPSS (n = 117), and evaluate the feasibility and efficacy of P-EPSS-assisted closure in different clinical situations. In conclusion, EPSS could achieve secure complete closure of mucosal defect. P-EPSS could shorten the procedure and yield complete closure of mucosal defects rather than the C-EPSS closure-type.