Published online Mar 7, 2024. doi: 10.3748/wjg.v30.i9.1143
Peer-review started: December 1, 2023
First decision: January 4, 2024
Revised: January 4, 2024
Accepted: February 2, 2024
Article in press: February 2, 2024
Published online: March 7, 2024
Processing time: 95 Days and 14.9 Hours
Endoscopic full-thickness resection (EFTR) is increasingly employed in patients with deep lesions, such as submucosal tumors (SMTs), due to its minimal invasiveness and preservation of stomach anatomy and function. EFTR is considered a last-resort endoscopic treatment, like surgical resection, as it allows for the removal of deeper lesions and enables more comprehensive histological assessment. However, during SMT treatment with EFTR, the lesion is completely removed through intentional perforation, necessitating the closure of the resulting wound. Effective closure of the gastric wall defect is crucial for patient safety and the successful implementation of EFTR. Inadequate closure may lead to a higher risk of delayed perforation, requiring subsequent surgical intervention. In recent years, a variety of closure techniques have been utilized to suture gastric wall defects following EFTR. These methods include wound clipping, endoscopic stapling, the endoscopic full-layer folding system, the over-the-scope-clip system, the OverstitchTM endoscopic suturing system, and bioabsorbable fillers. While some of these techniques are straightforward to execute, they may not achieve complete closure for larger perforations of the gastric wall. On the other hand, certain advanced endoscopic devices are relatively expensive and demand a higher level of expertise, limiting their widespread adoption in medical institutions.
To find a more economical, practical and convenient wound closure method for large wound after EFTR.
The double-nylon rope purse-string suture technique is a viable, effective, and safe method for closing gastric wall defects following EFTR for gastric SMTs. It offers several advantages over traditional and previously reported methods, including ease of operation, cost-effectiveness, and favorable prognostic outcomes. It is hoped that additional studies will be conducted to enhance the scientific understanding of this closure method and ultimately benefit a larger number of patients.
This study was a retrospective single-arm clinical trial. This study aimed to evaluate the clinical value of double-nylon purse-string sutures in closing gastric defects following submucosal tumor treatment with endoscopic full-thickness resection. We selected tumors larger than 3 cm, which had not been seen in previous studies. This new endoscopic closure method was proposed on the premise of rich clinical cases and operational experience in our center.
The double-nylon rope purse-string suture technique is a viable, effective, and safe method for closing gastric wall defects following EFTR for gastric SMTs.
The double-nylon rope purse-string suture method is safe and effective, particularly for lesions with a diameter of 3 cm or larger located in the fundus of the stomach or the lesser curvature of the gastric body.
From this study, we propose a new endoscopic closure method. In addition to the good practice results in the stomach, we will continue to validate the effectiveness and safety of this approach in other parts of the digestive tract. It is hoped that this study can be continued in multi-center in the future.