Tala Mahmoud1, Louis M Wong Kee Song1, Stavros N Stavropoulos2, Tarek H Alansari2, Hemchand Ramberan3, Norio Fukami4, Neil B Marya5, Prashanth Rau5, Christopher Marshall5, Bachir Ghandour6, Michael Bejjani6, Mouen A Khashab6, Gregory B Haber7, Hiroyuki Aihara8, Mainor R Antillon-Galdamez9, Vinay Chandrasekhara1, Barham K Abu Dayyeh1, Andrew C Storm1. 1. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA. 2. Division of Gastroenterology and Hepatology, Department of Medicine, New York University School of Medicine-NYU Langone Hospital Long Island, Mineola, New York, USA. 3. Riverside Health System, Newport News, Virginia, USA. 4. Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA. 5. Division of Gastroenterology and Hepatology, UMASS Memorial Medical Center, Worchester, Massachusetts, USA. 6. Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA. 7. Division of Gastroenterology, Center of Advanced Therapeutic and Innovation, NYU Langone Health, New York, New York, USA. 8. Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. 9. Division of Gastroenterology and Hepatology, Mayo Clinic Health System, Eau Claire, Wisconsin, USA.
Abstract
BACKGROUND AND AIMS: Closure of endoscopic resection defects can be achieved with through-the-scope clips, over-the-scope clips, or endoscopic suturing. However, these devices are often limited by their inability to close large, irregular, and difficult-to-reach defects. Thus, we aimed to assess the feasibility and safety of a novel through-the-scope, suture-based closure system developed to overcome these limitations. METHODS: This was a retrospective multicenter study involving 8 centers in the United States. Primary outcomes were feasibility and safety of early use of the device. Secondary outcomes were assessment of need for additional closure devices, prolonged procedure time, and technical feasibility of performing the procedure with an alternative device(s). RESULTS: Ninety-three patients (48.4% women) with mean age 63.6 ± 13.1 years were included. Technical success was achieved in 83 patients (89.2%), and supplemental closure was required in 24.7% of patients (n = 23) with a mean defect size of 41.6 ± 19.4 mm. Closure with an alternative device was determined to be impossible in 24.7% of patients because of location, size, or shape of the defect. The use of the tack and suture device prolonged the procedure in 8.6% of cases but was considered acceptable. Adverse events occurred in 2 patients (2.2%) over a duration of follow-up of 34 days (interquartile range, 13-93.5) and were mild and moderate in severity. No serious adverse events or procedure-related deaths occurred. CONCLUSIONS: The novel endoscopic through-the-scope tack and suture system is safe, efficient, and permits closure of large and irregularly shaped defects that were not possible with established devices.
BACKGROUND AND AIMS: Closure of endoscopic resection defects can be achieved with through-the-scope clips, over-the-scope clips, or endoscopic suturing. However, these devices are often limited by their inability to close large, irregular, and difficult-to-reach defects. Thus, we aimed to assess the feasibility and safety of a novel through-the-scope, suture-based closure system developed to overcome these limitations. METHODS: This was a retrospective multicenter study involving 8 centers in the United States. Primary outcomes were feasibility and safety of early use of the device. Secondary outcomes were assessment of need for additional closure devices, prolonged procedure time, and technical feasibility of performing the procedure with an alternative device(s). RESULTS: Ninety-three patients (48.4% women) with mean age 63.6 ± 13.1 years were included. Technical success was achieved in 83 patients (89.2%), and supplemental closure was required in 24.7% of patients (n = 23) with a mean defect size of 41.6 ± 19.4 mm. Closure with an alternative device was determined to be impossible in 24.7% of patients because of location, size, or shape of the defect. The use of the tack and suture device prolonged the procedure in 8.6% of cases but was considered acceptable. Adverse events occurred in 2 patients (2.2%) over a duration of follow-up of 34 days (interquartile range, 13-93.5) and were mild and moderate in severity. No serious adverse events or procedure-related deaths occurred. CONCLUSIONS: The novel endoscopic through-the-scope tack and suture system is safe, efficient, and permits closure of large and irregularly shaped defects that were not possible with established devices.