Efficacy of single-clamp endoscopic 8-shaped suture for closure of iatrogenic perforation in the upper digestive tract

Abstract

Objective To investigate the clinical efficacy of single-clamp endoscopic 8-shaped suture for closure of iatrogenic perforation in the upper digestive tract following endoscopic full-thickness resection (EFTR). Methods We retrospectively analyzed the data of 38 patients with upper gastrointestinal submucosal tumors (SMT) with a diameter greater than 2 cm, which originated from the deep muscularis of the muscularis propria with bidirectional growth and were confirmed by preoperative abdominal CT and endoscopic ultrasonography in the Digestive Endoscopy Center of our hospital between November, 2018 and July, 2019. All these patients underwent EFTR of tumor, which resulted in iatrogenic perforation in the upper digestive tract. Single-clamp endoscopic 8-shaped suture was used to close the perforation, and the intra- and postoperative complications and postoperative follow-up data were analyzed to assess the feasibility, safety and efficacy of the approach. Results The patients had an average tumor diameter of 2.6±0.8 cm and a mean wound diameter of 3.8±0.5 cm. The perforation was successfully repaired in all the 38 cases with a mean suture time of 12.6±1.8 min. Six (15.8%) of the patients complained of abdominal pain and bloating after the operation, and 4 (10.5%) patients had fever postoperatively, which was transient in 3 cases and as a result of infection due to failure of suture disconnection in the other case. None of the patients had serious intraoperative and postoperative complications or conversion to open surgery during the operation. The postoperative hospital stay was 5-9 d, and the endoscopic wounds healed well at 1 month after the operation in all the cases with visible scar formation. Follow-up endoscopy at 3 months postoperatively revealed good wound healing without signs of tumor recurrence. Conclusion Single-clamp endoscopic 8-shaped suture can effectively repair iatrogenic perforation after EFTR, which has good safety and less invasiveness with a low cost and a low risk of conversion to open surgery.

Keywords

• active iatrogenic perforation
• 8-shaped suture
• gastroscopy