Closure techniques in exposed endoscopic full-thickness resection: Overview and future perspectives in the endoscopic suturing era

Table 1 Summary of studies reporting post-endoscopic full-thickness resection defect closure by the use of endoclips

Ref.	Study design	Lesions, n	Mean tumor size (range), cm	Site (cardia/antrum/ body/fundus)	R0	Surgical conversion	Suture technique	Suture technical success	Mean operation time (range), min	Mean suture time (range), min	Major adverse events
Zhou et al[4], 2011	R	26	2.8 ± 1.3 (1.2-4.5)	0/0/14/12	26	0	Clips +/- omental- patch	26	105 (60-145)	-	0
Huang et al[7], 2014	R	35	2.8 (2.0-4.5)	0/0/21/14	35	0	Clips +/- omental- patch	35	90 (60-155)	-	0
Dong et al[12], 2014	R	10	1.65 ± 0.59 (0.80-2.50)	1/1/1/7	10	0	Clips	10	120 (60-180)	-	Peritonitis and abdominal abscess (n = 1)
Feng et al[8], 2014	R	48	1.59 ± 1.01 (0.50-4.80)	0/1/7/40	48	0	Clips	48	59.7 (30-270)	-	0
Wu et al[9], 2015	R	50	3.40 ± 0.83 (2.50-5.00)	0/13/23/14	50	0	Clips +/- omental- patch	50	85 (55-155)	-	0
Tang et al[15], 2016	R	6	-	0/1/2/3	-	0	CFCM	6	-	14.83 ± 1.94 (-)	0
Lu et al[10], 2016	R	62	2.23 ± 1.80 (0.60-6.00)	0/0/29/33	61	0	Clips	62	NA (n = 30): 85 (40-180); TWC (n = 21): 45 (25-90); LA (n = 11): 40 (30-75)	-	0
Tan et al[13], 2017	R	32	1.54 ± 0.66 (-)	0/0/7/25	-	1	Clips	62	69.1 ± 27.0 (-)	6.3 ± 1.6 (-)	Delayed bleeding (n = 1)
Abe et al[11], 2018	R	14	-	-	14	3	Clips	11	-	-	0
Zhao et al[14], 2019	R	85	1.60 ± 0.88 (-)	6/4/20/55	81	0	Clips	85	-	-	Abdominal infection (n = 1)

R: Retrospective; CFCM: Clips assisted with foreign body forceps clip method.

Table 2 Summary of studies reporting post-endoscopic full-thickness resection defect closure by the use of endoclips combined with endoloops

Ref.	Study design	Lesions, n	Mean tumor size (range), cm	Site (cardia/antrum/ body/fundus)	R0	Surgical conversion	Suture technique	Suture technical success	Mean operation time (range), min	Mean suture time (range), min	Major adverse events
Shi et al[17], 2013	R	20	1.47 ± 0.87 (0.40-3.00)	0/1/7/12	20	0	EMCIS	20	-	10 (8-20)	0
Ye et al[18], 2014	R	51	2.40 ± 0.73 (1.30-3.50)	0/1/22/28	50	1 (resection failure)	Clips + endoloop ligature	50	52 (30-125)	-	0
Zhang et al[19], 2014	R	29	1.9 ± 1.1 (0.3–4.2)	0/0/2/27	29	0	EPSS	29	55.7 ± 15.4 (35–95)	-	0
Tang et al[15], 2016	R	12	-	0/1/4/7	-	0	EPSS	12	-	22.42 ± 5.73	0
Shi et al[21], 2017	R	68	2.60 ± 0.50 (2.00-3.50)	0/0/0/68	68	0	EPSS	68	41 (23-118)	13 (9-21)	Delayed bleeding (n = 1)
Hu et al[22], 2017	P	13	1.50 ± 1.00 (0.50-3.50)	0/0/2/11	13	0	GAL	13	43.5 (20-80)	9.4 (3–18)	0
Wu et al[23], 2018	R	25	1.70 ± 1.00 (0.50-4.50)	0/0/7/18	25	0	p-EPSS	25	31 (-)	-	0
Li et al[20], 2019	R	28	1.55 ± 0.4 (-)	0/0/9/19	-	0	EPSS	28	-	-	0

R: Retrospective; EMCIS: Endoloop and metallic clip interrupted-suture; EPSS: Endoscopic purse-string suture; GAL: Grasp-and-loop; p-EPSS: Prepurse-string suture.

Table 3 Summary of studies reporting post-endoscopic full-thickness resection defect closure by the use of over-the-scope clips

Ref.	Study design	Lesions, n	Mean tumor size (range), cm	Site (cardia/antrum/ body/fundus)	R0	Surgical conversion	Suture technique	Suture technical success	Mean operation time (range), min	Mean suture time (range), min		Major adverse events
Guo et al[25], 2015	R	23	1.21 ± 0.47 (0.6-2.0)	0/3/9/11	23	0	OTSC	23	40.5 ± 25.8 (16–104)		4.9 ± 2.2 (2–12)	0
Wang et al[26], 2019	CS	2	1.1 (1-1.2)	0/0/1/1	2	0	OTSC	2	108.5 (48-121)		43 (16-70)	0
Hu et al[27], 2020	R	20	2.4 ± 0.26 (-)	0/0/0/20	20	0	OTSC +/- clips	20	130.6 ± 51.9 (-)		-	0

R: Retrospective; OTSC: Over-the-scope clip; CS: Case series.

Table 4 Summary of studies reporting post-endoscopic full-thickness resection defect closure by the use of endoscopic suturing systems

Ref.	Study design	Lesions, n	Mean tumor size (range), cm	Site (cardia/antrum/ body/fundus)	R0	Surgical conversion	Suture technique	Suture technical success	Mean operation time (range), min	Mean suture time (range), min	Major adverse events
Andalib et al[35], 2018	CS	7	-	-	-	0	ESS	7	-	-	0
Xu et al[36], 2018	CR	1	2.4	0/0/0/1	1	0	ESS	1	-	-	0
Granata et al[37], 2018	CR	1	-	0/0/1/0	-	0	ESS (3 running sutures)	1	-	-	0
Dedania et al[38], 2018	CR	1	1.5	0/0/1/0	.	0	ESS (2 running sutures)	1	-	-	0
Inayat et al[40], 2019	CS	3	2.35 (1.85-3.20)	2/0/0/1	-	0	Clips omental-patch + ESS	3	-	-	0
Kerdsirichairat et al[41], 2019	CR	1	-	1/0/0/0	1	0	Clips omental-patch + ESS	1	-	-	0
Sachdev et al[42], 2020	CS	2	3.15 (2.8-3.5)	2/0/0/0	-	0	Clips omental-patch + ESS	2	-	-	0
Modayil et al[39], 2020	CR	1	2.5	0/0/0/1	1	0	ESS (1 running suture)	1	-	-	0

CS: Case series; ESS: Endoscopic suturing system; CR: Case report.