ENDOSCOPIC SUTURING RESULTS IN HIGH TECHNICAL AND CLINICAL SUCCESS RATES FOR A VARIETY OF GASTROINTESTINAL PATHOLOGY
Zachary M. Callahan*1, Bailey Su1,2, Kristine Kuchta1, John G. Linn1, Faris Murad1, Stephen P. Haggerty1, Woody Denham1, JoAnn Carbray1, Michael Ujiki1
1Surgery, Northshore HealthSystem, Evanston, IL; 2Surgery, University of Chicago, Chicago, IL
Introduction: Gastrointestinal (GI) tract defects develop in numerous clinical situations, such as iatrogenic injury during endoscopy, pathologic perforation of ulcers, and during lesion resection. Historically, these problems were addressed surgically, however, morbidity and mortality associated with these operations can be significant. An endoscopic suturing system (ESS) allows for endoscopic closure of these defects and has other applications. This abstract reports our institutional experience with endoscopic suturing.
Methods: This is a retrospective review of patients who underwent therapy with an ESS. The enterprise data warehouse, which includes hospital and professional billing, was queried. Chart review was completed ensuring use of the device as dictated in the operative note; duplicate and erroneous entries were excluded. Definitions of technical and clinical success were established for each application.
Results: Endoscopic suturing was used 162 times between June 2012 and September 2018. Overall technical and clinical success was 97.5% and 71.2%. By location, 73.5% of uses occurred in the stomach, followed by 14.8% of uses occurring in the esophagus, 4.3% in the small bowel and 3.7% in the colon. The system was used 24 times to address anastomotic leak or fistula with a technical and clinical success rate of 95.8% and 55.6%. Eleven stent fixations had technical and clinical success of 100% and 72.7%. An ESS was used to close intentional mucosal and submucosal defects 19 times. Technical and clinical success was 89.5% and 82.4%. Nine full thickness perforations were repaired with a technical and clinical success of 88.9% and 87.5%. Five marginal ulcers were oversewn with a 100% technical success rate and an 80% clinical success rate. Diverticulopexy in the esophagus was technically and clinically successful in two patients. An ESS was used in endoscopic sleeve gastroplasty in 14 patients with a 100% technical success rate. Excess body weight loss (EBWL) was 24.6 ± 30.8% at six months. Seventy-seven patients underwent endoscopic gastrojejunostomy revision after gastric bypass with a 100% technical success rate. At two years follow up, 70% of patients had lost weight (EBWL 11.6 ± 19.8%).
Conclusions: Endoscopic suturing has been used successfully in numerous situations spanning all parts of the GI tract. High rates of technical and clinical success were seen in many applications and often prevented subsequent invasive procedures.
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