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Closing the Gaps: Endoscopic Suturing for Large Submucosal and Full-Thickness Defects
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Keshav Kukreja, Suma Chennubhotla, Bharat Bhandari, Ankit Arora, Shashideep Singhal
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Clin Endosc 2018;51(4):352-356. Published online March 5, 2018
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DOI: https://doi.org/10.5946/ce.2017.117
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Abstract
PDFPubReaderePub
- This article is a systematic review of relevant literature on endoscopic suturing as a primary closure technique for large submucosal and full-thickness defects after endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), and endoscopic full-thickness resection (EFTR). A comprehensive literature search was conducted through 2016 by using PubMed, to find peer-reviewed original articles. The specific factors considered were the procedural indications and details, success rates, clinical outcomes including complications, and study limitations. Six original articles were included in the final review: two with non-human subjects and four with human subjects. The mean success rate of endoscopic suturing was 97.4% (100% for human subjects and 95.4% for non-human subjects). The procedural time ranged from 7 to 89 min. The average size and depth of lesions were 2.71 cm (3.74 cm [human] and 1.96 cm [non-human]) and 1.52 cm, respectively. The technique itself had no reported impact on mortality. In conclusion, endoscopic suturing is a minimally invasive technique for the primary closure of defects caused by EMR, ESD, and EFTR, with a high success and low complication rate.
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Citations
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Endoscopic Sleeve Gastroplasty - A New Tool to Manage Obesity
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Deepanshu Jain, Bharat Singh Bhandari, Ankit Arora, Shashideep Singhal
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Clin Endosc 2017;50(6):552-561. Published online June 13, 2017
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DOI: https://doi.org/10.5946/ce.2017.032
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Abstract
PDFPubReaderePub
- Obesity is a growing pandemic across the world. Dietary restrictions and behavior modifications alone have a limited benefit. Bariatric surgery, despite being the current gold standard, has limited acceptance by patients due to cost and associated morbidity. In our review, we have discussed nine original studies describing endoscopic sleeve gastroplasty (ESG). A total of 172 subjects successfully underwent ESG. Of 65 subjects with follow up data, 95.4% (62/65) had intact gastric sleeve confirmed via esophagogastroduodenoscopy or oral contrast study at the end of study specific follow up interval (the longest being 6 months). Individual studies reported a technical success rate for intact gastric sleeve from as low as 50% to as high as 100%. A statistically significant (p<0.05) weight loss was reported in seven of the eight studies with available data. None of the patients experienced any intra-procedure complications, and approximately 2.3% (4/172) of patients experienced major post-procedure complications; however, no mortality was reported. Majority of the studies reported relatively high incidence of minor post-procedure complications, which improved with symptomatic treatment alone. Good patient tolerance with comparable clinical efficacy in achieving and sustaining desired weight loss makes ESG an attractive option to consider among other bariatric therapies.
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