SUCCESSFUL ANTI-REFLUX OF POST-ESOPHAGECTOMY USING ENDOSCOPIC SUTURING WITH OVERSTITCHTM
Xuan Li*, Guoxin Zhang
the First Affiliated Hospital of Nanjing Medical University, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
Backgroud: The reflux of gastric contents into the esophagus is a common complication post-esophagectomy. We aimed to suturing the anastomosis by overstitch in treatment of regurgitation.
Methods: Data of patients suffered from regurgitation post-proximal partial gastrectomy who underwent endoscopic suturing closure between October 2017 and September 2018 at Jiangsu Province Hospital (Jiangsu, China) were retrospectively reviewed. we performed an anti-flow barrier by endoscopic suturing closure as follows: First, we observed the position of anastomosis by use of conventional endoscope. Second, an overtube was placed into esophagus. Third, the double lumen endoscopy was equipped with overstitchTM. Fourth, tissue helix and 2/0 Prolene suture stitch were inserted into the double lumen, and 3cm distal to the anastomosis was stitched by Z-line stitching.
Results: A total of 4 patients were underwent an anti-flow barrier by endoscopic suturing closure. We carried our 4 stitch by use of 1 suture. The average operation time was 65min without adverse events. Patients accepted gastroscopy 6-months post-procedure, which showed the narrowed anastomosis and chyme retention in the gastric remnant. Simultaneously, symptoms are significantly relieved. Mean DeMeester score and Gerd-Q score was significant decreased.
Conclusion: Our study here continues to raise the potential anti-reflux effect of endoscopic suturing closure.
Closure was obtained as following. A: the position of anastomosis by use of conventional endoscope; B-C: Continuous suturing; D: Anastomosis after closure. 
The gastroscopic examination pre-procedure and 3-months post-procedure. A: Anastomosis per-procedure; B: Anastomosis 3-months post-procedure; C: An anti-flow barrier (black arrow) and chyme (white arrow) 3-months post-procedure.
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