|
Back to 2017 Posters
RETROSPECTIVE ANALYSIS OF 103 CASES USING A NOVEL, FULL-THICKNESS ENDOSCOPIC SUTURING DEVICE
Brandon Johnson*1, Herbert M. Hedberg3,1, Tyler Hall1, John G. Linn3,1, Faris Murad2, Michael Ujiki3,1
1Grainger Center for Surgical Innovation, NorthShore University HealthSystem, Evanston, IL; 2Gastroenterology, NorthShore University HealthSystem, Evanston, IL; 3General Surgery, NorthShore University HealthSystem, Evanston, IL
Introduction: Advanced endoscopic surgical techniques have evolved in the treatment of many gastrointestinal diseases. One promising technology is the use of endoscopic suturing devices within the GI tract. The purpose of this study was to review technical and clinical outcomes of cases using a novel endoscopic suturing device.
Methods: An IRB-approved retrospective study was conducted on cases performed by three surgeons using a full-thickness endoscopic suturing device from 2012 to 2016. Cases included chronic fistula closure, gastroesophageal stent fixation, endoscopic submucosal dissection (ESD), peroral endoscopic myotomy (POEM), endoscopic gastrojejunal revision (EGJR), acute perforation repair, and Zenker’s diverticulostomy closure. Technical success was defined as the ability to address the defect using the suturing device. Clinical success was uniquely determined for each case type. Clinical outcomes were verified radiographically or with postoperative EGD when possible.
Results: Three surgical endoscopists performed 103 cases on 89 patients using the OverStitchTM (Apollo Endosystems) full-thickness endoscopic suturing device. Fifty-nine EGJR cases were performed and all were technically successful (stoma reduced to ≤10 mm). In 54 of 59 cases (91.5%), patients demonstrated significant weight loss, averaging 13.0% excess weight lost at 6 months postoperatively. Technical success was achieved in 16 of 17 chronic fistula cases (94.1%). Eight fistula cases (47.1%) demonstrated full closure at 6 months postoperatively. All 11 POEM procedures accomplished full closure of the mucosal defect with no postoperative leaks. Sutures were successfully placed using the device during 8 of 9 stent fixations (88.9%). Six stent fixations (66.7%) were clinically successful and demonstrated no migration post-procedure; two migrations occurred in a single patient. All stents were covered and placed for benign etiology. Four acute perforations (66.7%) were completely closed with the device and were considered technically successful. Of the 4 successful closures, all showed no persistent leaks at 6 months postoperatively. Complete closure of the mucosal defect was accomplished in all 5 ESD cases and all patients were asymptomatic at 6 months postoperatively. One of the Zenker’s diverticulostomy closures was technically and clinically successful; in the other case, visualization was not obtainable and closure could not be accomplished with the device.
Conclusion: High rates of technical success were achieved across all case types. Clinical success was variable; ESD, EGJR and POEM procedures were highly successful at 6 months postoperatively while chronic fistula closures experienced the highest rates of clinical failure post-procedure. The endoscopic suturing device used in this study represents a viable first option for repair in many gastrointestinal cases.
Back to 2017 Posters
|
