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Multipurpose Use of an Endoscopic Suturing Device
Brandon J. Johnson, Matthew E. Gitelis*, John G. Linn, Woody Denham, Joann Carbray, Michael B. Ujiki
NorthShore University HealthSystem, Chicago, IL
Background: Aiming to minimize patient recovery and post-surgical discomfort, endoscopic surgical interventions often represent a desirable alternative to open or laparoscopic techniques. This study aimed to assess the efficacy of a novel endoscopic suturing device (Overstitch¬TM, Apollo Endosurgery, Austin TX) during a variety of endoscopic surgical procedures including: fistula closure, gastroesophageal (GE) stent fixation, endoscopic gastrojejunal revision (EGJR) after gastric bypass, endoscopic submucosal dissection (ESD), and peroral endoscopic myotomy (POEM).
Methods: An institutional review board-approved retrospective analysis of 51 patients who underwent surgical procedures using an endoscopic suturing device was performed. Eight patients underwent fistula closure (gastrogastric-5, nephroduodenal-1, colocutaneous-1, gastrocutaneous-1), four GE stent fixation, thirty-five EGJR, three ESD, and five POEM. Four patients had fistula closure at the time of the EGJR procedure. Technical success was uniquely defined for the type of intervention performed. Fistula closure was evaluated radiographically and/or with upper endoscopy. Stent fixation was observed post-operatively for migration with upper endoscopy. Successful EGJR was defined as a reduction of the stoma diameter to between 4 and 10 mm. All procedures, including ESD and POEM, were evaluated for leaks, perforations, and excessive bleeding in addition to other intra- and post-operative complications.
Results: Mean age was 55.6 ± 13.1 years and 21% were male. Six of eight patients experienced successful fistula closure. The two failures included patients who presented with irradiated fistulas. No migrations were observed in the four patients undergoing GE stent fixation. Two of three patients underwent ESD without complication. One intra-operative perforation occurred which was subsequently closed laparoscopically. All five POEM cases demonstrated successful closure of the mucosal defect with the suturing device. In thirty-five EGJR cases, all saw a reduction of the stoma to within the desired range, with patients experiencing an average 78.5% reduction in stoma size overall. One patient experienced post-operative bleeding due to a marginal ulcer at the gastrojejunal anastomosis which required a second endoscopic intervention to manage.
Conclusion: This case series demonstrated a multitude of scenarios where an endoscopic suturing device can be successfully applied. For many procedures that traditionally required an open or laparoscopic intervention, an endoscopic approach to closure can now be considered as a first option.
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