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Yang H, Jin X, Wang Y, Mao X, Ye L, Fang L, Yan L. Improved Paired-Kiss Suture Technique for Wound Closure After Colonic Endoscopic Submucosal Dissection (with Video). Dig Dis Sci 2024:10.1007/s10620-024-08645-w. [PMID: 39369171 DOI: 10.1007/s10620-024-08645-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2024] [Accepted: 09/10/2024] [Indexed: 10/07/2024]
Affiliation(s)
- Haideng Yang
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, 150 Ximen Street, Linhai, Zhejiang, China
| | - Xiuxiu Jin
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, 150 Ximen Street, Linhai, Zhejiang, China
| | - Yi Wang
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, 150 Ximen Street, Linhai, Zhejiang, China
| | - Xinli Mao
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, 150 Ximen Street, Linhai, Zhejiang, China
| | - Liping Ye
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, 150 Ximen Street, Linhai, Zhejiang, China
| | - Lina Fang
- Endoscopy Center, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, 150 Ximen Street, Linhai, Zhejiang, China
| | - Lingling Yan
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, 150 Ximen Street, Linhai, Zhejiang, China.
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Papaefthymiou A, Norton B, Telese A, Murray C, Murino A, Johnson G, Tsiopoulos F, Simons-Linares R, Seghal V, Haidry R. Endoscopic suturing and clipping devices for defects in the GI tract. Best Pract Res Clin Gastroenterol 2024; 70:101915. [PMID: 39053973 DOI: 10.1016/j.bpg.2024.101915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 05/02/2024] [Indexed: 07/27/2024]
Abstract
Gastrointestinal luminal defects, including perforations, leaks and fistulae, pose persistent obstacles in endoscopic therapeutic interventions. A variety of endoscopic approaches have been proposed, with through-the-scope clipping (TTSC), over-the-scope clipping (OTSC) and suturing representing the main techniques of tissue apposition. However, the heterogeneity in defect morphology, the technical particularities of different locations in the gastrointestinal (GI) tract and the impact of various parameters on the final outcome, do not allow distinct conclusions and recommendations on the optimal approaches for defect closure, and, thus, current practice is based on endoscopists experience and local availability of devices. This review aims to collect the existing evidence on tissue apposition devices, in order to outline the role of every device on specific indications.
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Affiliation(s)
| | - Benjamin Norton
- Division of Gastroenterology, Cleveland Clinic, London, UK; Division of Surgery and Interventional Science, University College London, London, UK
| | - Andrea Telese
- Division of Gastroenterology, Cleveland Clinic, London, UK; Division of Surgery and Interventional Science, University College London, London, UK
| | - Charlie Murray
- Division of Gastroenterology, Cleveland Clinic, London, UK
| | - Alberto Murino
- Division of Gastroenterology, Cleveland Clinic, London, UK
| | - Gavin Johnson
- Division of Gastroenterology, Cleveland Clinic, London, UK
| | - Fotios Tsiopoulos
- Division of Gastroenterology, General Hospital of Larissa, Larissa, Greece
| | - Roberto Simons-Linares
- Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, 44195, United States
| | - Vinay Seghal
- Endoscopy Department, University College London Hospitals, London, UK
| | - Rehan Haidry
- Division of Gastroenterology, Cleveland Clinic, London, UK.
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Ogiyama H, Kato M, Yamaguchi S, Kanesaka T, Yamada T, Yamamoto M, Komori M, Nagaike K, Nakahara M, Tsutsui S, Tsujii Y, Saita R, Iijima H, Hayashi Y, Takehara T. Efficacy of prophylactic clip closure in reducing the risk of delayed bleeding after colorectal endoscopic submucosal dissection in patients on anticoagulant therapy: Multicenter prospective study. Dig Endosc 2024. [PMID: 38375544 DOI: 10.1111/den.14761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/09/2024] [Indexed: 02/21/2024]
Abstract
OBJECTIVES The high rate of delayed bleeding after colorectal endoscopic submucosal dissection (ESD) in patients undergoing anticoagulant therapy remains a problem. Whether prophylactic clip closure reduces the rate of delayed bleeding in these patients is unclear. This study aimed to evaluate the efficacy of prophylactic clip closure in patients receiving anticoagulants. METHODS This multicenter prospective interventional trial was conducted at nine referral centers in Japan. Patients regularly taking anticoagulants, including warfarin potassium or direct oral anticoagulants, and undergoing ESD for colorectal neoplasms were enrolled. The discontinuation of anticoagulants was minimized according to recent guidelines. After the ESD, post-ESD ulcers were prophylactically closed using endoclips. The primary end-point was the incidence of delayed bleeding. The sample size was 45 lesions, and prophylactic clip closure was considered effective when the upper limit of the 90% confidence interval (CI) for delayed bleeding did not exceed 20%. RESULTS Forty-five lesions were used, and three were excluded. Complete closure was achieved in 41/42 lesions (97.6%). The overall delayed bleeding rate was low, at 4.9% (2/41; 90% [CI] 0.8-14.5), which was significantly lower than that at the prespecified threshold of 20% (P = 0.007). The median closure procedure time was 17 min, and the median number of clips was nine. No massive delayed bleeding requiring transfusion, interventional radiology, or surgery was observed, and no thromboembolic events were observed. CONCLUSION Prophylactic clip closure may reduce the risk of delayed bleeding following colorectal ESD in patients receiving anticoagulants. TRIAL REGISTRATION UMIN Clinical Trial Registry (UMIN000036734).
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Affiliation(s)
- Hideharu Ogiyama
- Departments of Gastroenterology and Hepatology, Itami City Hospital, Hyogo, Japan
- Departments of Gastroenterology and Hepatology, Ikeda Municipal Hospital, Osaka, Japan
| | - Minoru Kato
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan
| | | | - Takashi Kanesaka
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Takuya Yamada
- Department of Gastroenterology and Hepatology, Osaka Rosai Hospital, Osaka, Japan
| | - Masashi Yamamoto
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
| | - Masato Komori
- Department of Gastroenterology, Hyogo Prefectural Nishinomiya Hospital, Hyogo, Japan
| | - Koji Nagaike
- Department of Gastroenterology and Hepatology, Suita Municipal Hospital, Osaka, Japan
| | - Masanori Nakahara
- Departments of Gastroenterology and Hepatology, Ikeda Municipal Hospital, Osaka, Japan
| | - Shusaku Tsutsui
- Departments of Gastroenterology and Hepatology, Itami City Hospital, Hyogo, Japan
| | - Yoshiki Tsujii
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Ryotaro Saita
- Department of Medical Innovation, Osaka University Hospital, Osaka, Japan
| | - Hideki Iijima
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yoshito Hayashi
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tetsuo Takehara
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan
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Hu B, Ding H. Novel through-the-scope suturing system versus over-the-scope suturing for GI wall closure: bridging the gaps. Gastrointest Endosc 2024; 99:302-303. [PMID: 38237967 DOI: 10.1016/j.gie.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 08/25/2023] [Indexed: 01/23/2024]
Affiliation(s)
- Bowen Hu
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Huanfei Ding
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
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Canakis A, Dawod SM, Dawod E, Simons M, Di Cocco B, Westerveld DR, Trasolini RP, Berzin TM, Marshall CA, Abdelfattah AM, Marya NB, Smallfield GB, Kaspar M, Campos GM, Skef W, Kedia P, Smith TA, Aihara H, Moyer MT, Sampath K, Mahadev S, Carr-Locke DL, Sharaiha RZ. Efficacy, Feasibility, and Safety of the X-Tack Endoscopic HeliX Tacking System: A Multicenter Experience. J Clin Gastroenterol 2024:00004836-990000000-00261. [PMID: 38277501 DOI: 10.1097/mcg.0000000000001977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/04/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND AND AIMS The application of endoscopic suturing has revolutionized defect closures. Conventional over-the-scope suturing necessitates removal of the scope, placement of the device, and reinsertion. A single channel, single sequence, through-the-scope suturing device has been developed to improve this process. This study aims to describe the efficacy, feasibility, and safety of a through-the-scope suturing device for gastrointestinal defect closure. METHODS This was a retrospective multicenter study involving 9 centers of consecutive adult patients who underwent suturing using the X-Tack Endoscopic HeliX Tacking System (Apollo Endosurgery). The primary outcomes were technical success and long-term clinical success. Secondary outcomes included adverse events, recurrence, and reintervention rates. RESULTS In all, 56 patients (mean age 53.8, 33 women) were included. Suturing indications included fistula repair (n=22), leak repair (n=7), polypectomy defect closure (n=12), peroral endoscopic myotomy (POEM) site closure (n=7), perforation repair (n=6), and ulcers (n=2). Patients were followed at a mean duration of 74 days. Overall technical and long-term clinical success rates were 92.9% and 75%, respectively. Both technical and clinical success rates were 100% for polypectomies, POEM-site closures, and ulcers. Success rates were lower for the repair of fistulas (95.5% technical, 54.5% clinical), leaks (57.1%, 28.6%), and perforations (100%, 66.7%). No immediate adverse events were noted. CONCLUSION This novel, through-the-scope endoscopic suturing system, is a safe and feasible method to repair defects that are ≤3 cm. The efficacy of this device may be better suited for superficial defects as opposed to full-thickness defects. Larger defects will need more sutures and probably a double closure technique to provide a reinforcement layer.
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Affiliation(s)
- Andrew Canakis
- Department of Gastroenterology, University of Maryland Medical Center, Baltimore, MD
| | - Sanad Maher Dawod
- Department of Gastroenterology, Weill Cornell Medical Center, New York, NY
| | - Enad Dawod
- Department of Gastroenterology, Weill Cornell Medical Center, New York, NY
| | - Malorie Simons
- Department of Gastroenterology, Weill Cornell Medical Center, New York, NY
| | - Bianca Di Cocco
- Department of Gastroenterology, Weill Cornell Medical Center, New York, NY
| | | | | | - Tyler M Berzin
- Department of Gastroenterology, Beth Israel Deaconess Medical Center, Boston
| | | | | | - Neil B Marya
- Department of Gastroenterology, UMass Memorial Medical Center, Worcester, MA
| | - George B Smallfield
- Department of Gastroenterology, Virginia Commonwealth University, Richmond, VA
| | - Matthew Kaspar
- Department of Gastroenterology, Virginia Commonwealth University, Richmond, VA
| | - Guilherme M Campos
- Department of Gastroenterology, Virginia Commonwealth University, Richmond, VA
| | - Wasseem Skef
- Department of Gastroenterology, Loma Linda University Medical Center, Loma Linda, CA
| | - Prashant Kedia
- Department of Gastroenterology, Methodist Dallas Medical Center, Dallas, TX
| | - Terrence A Smith
- Department of Gastroenterology, Vanderbilt University Medical Center, Nashville, TN
| | - Hiroyuki Aihara
- Department of Gastroenterology, Brigham and Women's Hospital
| | - Matthew T Moyer
- Department of Gastroenterology, Penn State Health Milton S Hershey Medical Center. Hershey, PA
| | - Kartik Sampath
- Department of Gastroenterology, Weill Cornell Medical Center, New York, NY
| | - Srihari Mahadev
- Department of Gastroenterology, Weill Cornell Medical Center, New York, NY
| | - David L Carr-Locke
- Department of Gastroenterology, Weill Cornell Medical Center, New York, NY
| | - Reem Z Sharaiha
- Department of Gastroenterology, Weill Cornell Medical Center, New York, NY
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Abe S. Delayed Perforation after Gastric Endoscopic Submucosal Dissection: Proceed to Prompt Intervention If Acceptable. Gut Liver 2024; 18:1-2. [PMID: 38221814 PMCID: PMC10791504 DOI: 10.5009/gnl230545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2024] Open
Affiliation(s)
- Seiichiro Abe
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
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