Published online Jan 28, 2023. doi: 10.3748/wjg.v29.i4.731
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
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.
The novel invented P-EPSS should be analysed and compared with the conventional EPSS (C-EPSS) procedure.
Elucidate the outcomes of EPSS-assisted closure in different clinical situations, and evaluate the efficacy of P-EPSS.
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.
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.
EPSS could achieve secure complete closure of mucosal defect. P-EPSS could shorten the procedure and yield complete closure of mucosal defects.
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.