Radu Pescarus1, Eran Shlomovitz2, Ahmed M Sharata3, Maria A Cassera4, Kevin M Reavis3,4,5, Christy M Dunst3,4,5, Lee L Swanström3,4,5. 1. Department of General Surgery, Hôpital Sacré-Coeur, 5400 Boulevard Gouin, Montreal, QC, H4J 1C5, Canada. radupes@yahoo.com. 2. Division of General Surgery, Toronto General Hospital, 585 University Avenue, Toronto, ON, Canada. 3. Department of Surgery, Providence Portland Medical Center, 4805 NE Glisan St, Suite 6N60, Portland, OR, 97213, USA. 4. Gastrointestinal and Minimally Invasive Surgery Division, The Oregon Clinic, 3805 NE Glisan St, Suite 6N60, Portland, OR, 97213, USA. 5. Foundation for Surgical Innovation and Education, 4805 NE Glisan St., Suite 6N60, Portland, OR, 97213, USA.
Abstract
INTRODUCTION: Obtaining an adequate mucosal closure is one of the crucial steps in per-oral endoscopic myotomy (POEM). Thus far, there have been no objective data comparing the various available closure techniques. This case-controlled study attempts to compare the application of endoscopic clips versus endoscopic suturing for mucosotomy closure during POEM cases. METHODS: A retrospective review of our prospective POEM database was performed. All cases in which endoscopic suturing was used to close the mucosotomy were matched to cases in which standard endoclips were used. Overall complication rate, closure time and mucosal closure costs between the two groups were compared. RESULTS: Both techniques offer good clinical results with good mucosal closure and the absence of postoperative leak. Closure time was significantly shorter (p = 0.044) with endoscopic clips (16 ± 12 min) when compared to endoscopic suturing (33 ± 11 min). Overall, the total closure cost analysis showed a trend toward lower cost with clips (1502 ± 849 USD) versus endoscopic suturing (2521 ± 575 USD) without reaching statistical significance (p = 0.073). CONCLUSION: The use of endoscopic suturing seems to be a safe method for mucosal closure in POEM cases. Closure time is longer with suturing than conventional closure with clips, and there is a trend toward higher overall cost. Endoscopic suturing is likely most cost-effective for difficult cases where conventional closure methods fail.
INTRODUCTION: Obtaining an adequate mucosal closure is one of the crucial steps in per-oral endoscopic myotomy (POEM). Thus far, there have been no objective data comparing the various available closure techniques. This case-controlled study attempts to compare the application of endoscopic clips versus endoscopic suturing for mucosotomy closure during POEM cases. METHODS: A retrospective review of our prospective POEM database was performed. All cases in which endoscopic suturing was used to close the mucosotomy were matched to cases in which standard endoclips were used. Overall complication rate, closure time and mucosal closure costs between the two groups were compared. RESULTS: Both techniques offer good clinical results with good mucosal closure and the absence of postoperative leak. Closure time was significantly shorter (p = 0.044) with endoscopic clips (16 ± 12 min) when compared to endoscopic suturing (33 ± 11 min). Overall, the total closure cost analysis showed a trend toward lower cost with clips (1502 ± 849 USD) versus endoscopic suturing (2521 ± 575 USD) without reaching statistical significance (p = 0.073). CONCLUSION: The use of endoscopic suturing seems to be a safe method for mucosal closure in POEM cases. Closure time is longer with suturing than conventional closure with clips, and there is a trend toward higher overall cost. Endoscopic suturing is likely most cost-effective for difficult cases where conventional closure methods fail.
Authors: Mouen A Khashab; Ahmed A Messallam; Manabu Onimaru; Ezra N Teitelbaum; Michael B Ujiki; Matthew E Gitelis; Rani J Modayil; Eric S Hungness; Stavros N Stavropoulos; Mohamad H El Zein; Hironari Shiwaku; Rastislav Kunda; Alessandro Repici; Hitomi Minami; Philip W Chiu; Jeffrey Ponsky; Vivek Kumbhari; Payal Saxena; Amit P Maydeo; Haruhiro Inoue Journal: Gastrointest Endosc Date: 2015-01-26 Impact factor: 9.427
Authors: Ahmed M Sharata; Christy M Dunst; Radu Pescarus; Eran Shlomovitz; Aaron J T Wille; Kevin M Reavis; Lee L Swanström Journal: J Gastrointest Surg Date: 2014-09-03 Impact factor: 3.452
Authors: Lee L Swanstrom; Ashwin Kurian; Christy M Dunst; Ahmed Sharata; Neil Bhayani; Erwin Rieder Journal: Ann Surg Date: 2012-10 Impact factor: 12.969