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CC BY 4.0 · Endosc Int Open 2026; 14: a27779441
DOI: 10.1055/a-2777-9441
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Technical aspects of endoscopic internal drainage procedure, secured by endoscopic suture fixation: Experimental study

Authors

  • Joel Troya 

    1   Gastroenterology, Universitätsklinikum Würzburg, Medizinische Klinik und Poliklinik II, Würzburg, Germany (Ringgold ID: RIN368109)

  • Karl-Hermann Fuchs 

    1   Gastroenterology, Universitätsklinikum Würzburg, Medizinische Klinik und Poliklinik II, Würzburg, Germany (Ringgold ID: RIN368109)

  • Alexander Hann 

    2   Interventional and Experimental Endoscopy (InExEn), Department of Internal Medicine 2, Universitätsklinikum Würzburg, Würzburg, Germany (Ringgold ID: RIN27207)

  • Alexander Meining

    1   Gastroenterology, Universitätsklinikum Würzburg, Medizinische Klinik und Poliklinik II, Würzburg, Germany (Ringgold ID: RIN368109)
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Abstract

Techniques of interventional endoscopy such as implantation of stents, leak closure by clips, or endoscopic suturing can help in reducing risk of an unfavorable outcome for patients with fistulas in the gastrointestinal tract. One method is endoscopic internal drainage (EID), which has been reported to have remarkable success. Because dislocation can reduce success, endoscopic suture techniques have been applied; however, devices could be cumbersome and/or expensive. The purpose of this experimental study was to evaluation the new endoscopic suturing needle-holder SutuArt for fixation of internal drains at a gastric fistula site. This suturing system is a through-the-scope needle-holder, which can be rotated within the working channel 360 degrees and maneuvered with the endoscope tip in many positions. The experiment was performed using an explanted porcine stomach with attached esophagus. Three consecutive running stitches were performed to provide sufficient fixation of the drain at an experimental “fistula” site. Afterward, the force was measured to dislocate the fixed drain. The results of 12 measurements (median duration 23 minutes; range: 19–44) at 6.7 Newton were compared with the reference value of 12 Newton (full-thickness open-stitch), thus withstanding a substantial pulling force. In conclusion, this study demonstrates the conceptual possibility of using an endoscopic needle holder for suture-fixation of a drain. Further clinical investigations are required to establish a full feasibility test of the concept.

Keywords

Endoscopy Upper GI Tract - Endoscopic resection (ESD, EMRc, ...) - Dilation, injection, stenting - GI surgery


Publication History

Received: 17 April 2025

Accepted after revision: 03 October 2025

Accepted Manuscript online:
22 December 2025

Article published online:
14 January 2026

© 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Bibliographical Record
Joel Troya, Karl-Hermann Fuchs, Alexander Hann, Alexander Meining. Technical aspects of endoscopic internal drainage procedure, secured by endoscopic suture fixation: Experimental study. Endosc Int Open 2026; 14: a27779441.
DOI: 10.1055/a-2777-9441
 

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