Endoscopic Clips Versus Endoscopic Suture for Mucosal Closure after PER-ORAL Endoscopic Pyloromyotomy: a Prospective Single-Center Study

Aims G-POEM is an emerging method for treatment of gastroparesis (GP). Safe mucosal closure is necessary to avoid adverse events. The aim of this prospective study was to compare the effectivity of two closure methods: clips and endoscopic suturing (ES) in patients undergoing G-POEM.

Methods For a prospective study (NCT:03679104) were enrolled consecutive patients eligible for RCT (NCT 03356067) and who met exclusion criteria for RCT (Tab.1). The closure method was assigned at the discretion of an endoscopist prior to the procedure. The main outcome was the proportion of subjects with successful closure. Unsuccessful closure was defined as a need for a rescue method, or a need for an additional intervention or incomplete closure related adverse events. Secondary outcomes were easiness of closure (measured by a visual analogue scale; 0 = impossible, 10 = very easy, scored by endoscopist and nurse) and closure time.

Table 1	Clips	Suturing system
No of patients (non RCT/RCT)	7/13	5/15
Gender (M/F)	8/12	11/9
Age (mean, SD)	51.1 (±13.2)	44 (±14.8)
Etiology of GP (dGP/iGP/pGP)	8/5/7	7/6/7

Results A total of 40 patients [21 female; mean age 47.5;(20–74)] have been included; 20 received ES and 20 clips [mean number of clips 6;range(4–19)]. All patients with ES had successful closure. One patient with clips needed a rescue method (KING closure) and another needed additional clipping because of a leak on POD1. The remaining 18 patients (90 %) had a successful closure with clips. Closure with clips was quicker (mean closure time, range 9.8(4–20) vs 14.1(5–21)min;p = 0.002). Endoscopist assessed closure with ES easier compared to clips [mean VAS, range: 7.5(3–10)(ES) vs. 6.9(3–10)(clips); p = 0.16], nurses assessed easines of both closure methods as comparable (VAS 8(4–10)(ES) vs 8.3(5–10)(clips);p = 0.34].

Conclusions Endoscopic suturing system may be more reliable than clipping for mucosal closure in patients undergoing G-POEM. Besides clips, centers performing G-POEM should have an alternative (rescue) closure method. (Supported by grant 17-28797A).

Citation: Hustak R, Vackova Z, Krajciova J et al. OP18 ENDOSCOPIC CLIPS VERSUS ENDOSCOPIC SUTURE FOR MUCOSAL CLOSURE AFTER PER-ORAL ENDOSCOPIC PYLOROMYOTOMY: A PROSPECTIVE SINGLE-CENTER STUDY. Endoscopy 2021; 53: S11.

Publikationsverlauf

Artikel online veröffentlicht:
19. März 2021