Li MM, Zhang Y, Sun F, Huai MX, Zhang FY, Qu CY, Shen F, Li ZH, Xu LM. Feasibility and efficacy of endoscopic purse-string suture-assisted closure for mucosal defects induced by endoscopic manipulations. World J Gastroenterol 2023; 29(4): 731-743 [PMID: 36742166 DOI: 10.3748/wjg.v29.i4.731]
Corresponding Author of This Article
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
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
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 bythe 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
ARTICLE HIGHLIGHTS
Research background
Endoscopic purse-string assisted suturing (EPSS) has proven to be an effective and safe technique for the closure of large mucosal defects. Recently, the endoscopic pre-purse-string suture (P-EPSS) procedure was invented and was widely used in clinical.
Research motivation
The novel invented P-EPSS should be analysed and compared with the conventional EPSS (C-EPSS) procedure.
Research objectives
Elucidate the outcomes of EPSS-assisted closure in different clinical situations, and evaluate the efficacy of P-EPSS.
Research methods
The study included a total of 180 patients who underwent closure assisted by EPSS between July 2014 and June 2020. The P-EPSS (n = 63) and C-EPSS (n = 117) groups were compared and the intergroup differences in aspects such as the lesion size, location, and morphology, incidence of complete closure, intraoperative perforation, and delayed adverse events were evaluated.
Research 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 significantly higher proportion of intraoperative perforation and a much shorter procedure time. But the incidence of adverse events did not differ significantly between P-EPSS and C-EPSS groups. Lesions with incomplete closure or size greater than 3 cm showed a statistical tendency to result in an increase in delayed adverse events.
Research conclusions
EPSS could achieve secure complete closure of mucosal defect. P-EPSS could shorten the procedure and yield complete closure of mucosal defects.
Research perspectives
To eliminate the selection bias, we would dedicate to design a new cohort prospective study to compare the criteria of deciding in advance whether to use P-EPSS or C-EPSS before endoscopic manipulations.
