Esophageal overtubes provide no benefit to safety or technical success in upper gastrointestinal tract endoscopic suturing

Abstract

Background and study aim The role of esophageal overtubes in upper gastrointestinal endoscopic suturing is unknown. This study aimed to determine whether overtube use was associated with technical success or adverse events.

Patients and methods A retrospective review of consecutive patients who underwent endoscopic suturing for various indications was performed.

Results A total of 719 patients underwent endoscopic suturing for various indications, including endoscopic bariatric procedures in 262, stent fixation in 258, defect closure in 190, and hemostasis in nine. An overtube was used in 186 procedures (25.9 %). Technical success was achieved in all cases. Minor mucosal trauma occurred in 15 cases (8.1 %) with use of an overtube, and none without an overtube (P < 0.0001). No full-thickness esophageal perforation or hemorrhage related to overtube use or the suturing device occurred.

Conclusions Endoscopic suturing can be performed safely for a variety of indications, including endoscopic bariatric procedures, defect repair, and stent fixation without an esophageal overtube. Minor esophageal mucosal trauma and equipment cost are increased when an overtube is used.

• References

• 1 OverStitch™ [package insert]. Austin, TX: Apollo Endosurgery, Inc; 2018
• 2 Committee AT, Tierney WM, Adler DG. et al. Overtube use in gastrointestinal endoscopy. Gastrointest Endosc 2009; 70: 828-834
• 3 Dennert B, Ramirez FC, Sanowski RA. A prospective evaluation of the endoscopic spectrum of overtube-related esophageal mucosal injury. Gastrointest Endosc 1997; 45: 134-137
• 4 el-Newihi HM, Mihas AA. Esophageal perforation as a complication of endoscopic overtube insertion. Am J Gastroenterol 1994; 89: 953-954
• 5 Holderman WH, Etzkorn KP, Patel SA. et al. Endoscopic findings and overtube-related complications associated with esophageal variceal ligation. J Clin Gastroenterol 1995; 21: 91-94
• 6 Jeffries MA, Scheiman JM. Overtube separation. Gastrointest Endosc 1998; 47: 435-436
• 7 Sugi K, Miyoshi H, Murano M. et al. Endoscopic treatment for a gash in the esophagus caused when inserting the overtube during esophageal variceal ligation. Endoscopy 1997; 29: S44
• 8 Hill C, El Zein M, Agnihotri A. et al. Endoscopic sleeve gastroplasty: the learning curve. Endosc Int Open 2017; 5: E900-E904