Endoscopic hand suturing in the prevention of gastrointestinal bleeding after endoscopic submucosal dissection in the stomach

Aims Endoscopic hand-suturing (EHS) is a significant improvement in gastrointestinal advanced endoscopic procedures. Evidence supporting its effectiveness in clinical practice is limited due to its recent introduction and limited availability. This study aims to demonstrate the feasibility of EHS following advanced endoscopic submucosal dissection (ESD) in the stomach, emphasizing its potential to prevent gastrointestinal bleeding.

Methods The retrospective single-center study included individuals who underwent endoscopic submucosal dissection in the stomach. The resection site was either sutured, clipped, or left open. The study evaluated the overall procedure time (OPT), bleeding rate (BR), perforation rate, and length of hospital stay (HS). The bleeding risk of the participants matched the population risk. The assessment was conducted to compare the outcomes of “sutured vs. non-sutured” “closure vs. no closure” and “clipped vs. sutured” along with the propensity score matching analysis for reducing a potential selection bias.

Results One-hundred-seventy-nine patients were included in the analysis. All analyzed groups were equal demographically and in characteristics of the lesions. There were no perforations in the analyzed sample. BR and HS were similar regardless of the defect closure (BR: 5.2% vs. 4.0%; p=0.800; HS: 3 vs. 3 days; p=0.237). The BR was higher in non-sutured cases than in the sutured ones, but the difference did not reach statistical significance (5.5% vs 0.0%; p=0.335). The length of stay was similar regardless of the suturing (3 vs. 2 days; p=0.121). Closure of the defect after gastric ESD prolonged the procedure by approximately 22 minutes (40 vs. 62 min; p<0.05). Suturing prolonged that time by 17 min (40 vs. 57 min). There was no significant difference in OPT between clipping and suturing (70 vs. 57 min; p=0.315), and the BR was similar. However, the HS after clipping was remarkably longer (5 vs. 2 days; p<0.05). The propensity score matching of the groups revealed significant differences in early outcomes of sutured vs. non-sutured cases. The BR in the non-sutured group was higher (31.3% vs. 0.0%; p<0.05), and the HS in this group was longer (4 vs. 2 days; p<0.05). The OPT was insignificantly longer in the suturing group (58 vs. 45 min; p=0.476).

Conclusions The EHS is an effective technique for preventing postprocedural bleeding after ESD in the stomach in patients with no additional risk factors. Implementing the EHS did not prolong the procedure compared to clipping and may support earlier discharge. Challenges remain regarding the long learning curve and limited availability, which may hinder the wide usage of EHS. Further studies on the outcomes of EHS are in demand [1] [2] [3] [4] [5].

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025

• References

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