Complete Closure of Gastric Defect with Improved Purse-String Suture Technique Using Single-Channel Endoscope

Pure endoscopic resection versus laparoscopic assisted procedure for upper gastrointestinal stromal tumors: Perspective from a surgical endoscopist

“…In a series of 48 patients, of which 26 had full thickness defects after EFTR, mean closure time was 18 min and no patients suffered GI fistula or abscess. 32 In a separate series of 30 patients, no massive bleeding, leak or infection occurred after the full thickness closure with clip loop closure. 33 The Over-stitch (Apollo Endosurgery Inc., Austin, TX, USA) is one of the most commonly utilized endoscopic suturing devices, and in recent years, X-tack (Apollo Endosurgery Inc.) offers an alternative option of closure with the use of helical tacks attached to a suture.…”

“…Additional endoclips were added if the purse‐string closure was not tight. In a series of 48 patients, of which 26 had full thickness defects after EFTR, mean closure time was 18 min and no patients suffered GI fistula or abscess 32 . In a separate series of 30 patients, no massive bleeding, leak or infection occurred after the full thickness closure with clip loop closure 33 .…”

“…Finally, the endoloop is slowly tightened until the defect is closed. 32 Additional endoclips were added if the purse-string closure was not tight. In a series of 48 patients, of which 26 had full thickness defects after EFTR, mean closure time was 18 min and no patients suffered GI fistula or abscess.…”

“…Subsequently, the endoloop is attached along the edges of the defect symmetrically with endoclips. Finally, the endoloop is slowly tightened until the defect is closed 32 . Additional endoclips were added if the purse‐string closure was not tight.…”

“…It was not possible to close the gastric wall defect for 3 out of 33 patients who underwent endoscopic resection and conversion to laparoscopic closure was required 31 . In case of a larger defect, secure closure should be obtained with other adjunctive methods, such as clip loop purse‐string technique 32 and various endoscopic suturing techniques. In the clip loop purse‐string technique, the endoloop is first anchored to the distal edge of the defect with one endoclip.…”