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Endoscopic management of post-surgical GI wall defects with the overstitch endosuturing system: a single-center experience

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Abstract

Background and aims

Post-GI surgical wall defects are frequent and life-threatening complications, with limited literature regarding current treatment. This case series aims to assess the safety, feasibility, and outcomes of endoluminal therapy with the overstitch endoscopic suturing system (Apollo Endosurgery Inc, Austin).

Materials and methods

All patients who underwent endoscopic suturing for post-surgical wall defect management at IRCCS-ISMETT Palermo from October 2017 until January 2019 were retrospectively enrolled. Stratification therapy was applied according to the clinical scenario, time from surgery to endoscopic intervention, and structural condition of the wall defect layers (tissue status and suture feasibility). The therapeutic endoscopic strategy was divided into three groups (A: pure endoscopic direct suture; B: combined therapy with endoscopic direct suture + FC-SEMS placement + anchoring; C: FC-SEMS placement + anchoring). Success was considered the resolution of symptoms and the presence of a regular intestinal transit after a period of 4–6 weeks.

Results

Twenty (20) patients (male/female 7/13; mean age 54 ± 13.43 years) were included in the study (group A: 9 patients, group B: 7 patients, group C: 4 patients). The types of operative procedures were bariatric (9/20), post-tracheostomy (3/20), post-operative GI surgery (8/20). The post-surgical defects were predominantly intermediate and chronic (24–72 h: 1/20; 3–30 days: 13/20; > 30 days: 6/20). The overall clinical success was 80% (17/20 patients), with a success of 94% (16/17 patients) when excluding the three cases of tracheo-esophageal fistula. No evidence of migration was detected. The only complication was short stenosis of the distal esophagus, present in 4 patients (19%) and successfully treated with a novel lumen-apposing metal stent.

Conclusions

In our experience, considering the absence of clear guidelines, the endoluminal approach with the overstich endoscopic suturing system is a valid alternative to conventional therapy, offering mini-invasiveness, and presenting promising opportunities in terms of technical feasibility and clinical efficacy.

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Acknowledgements

We thank Mr. Warren Blumberg for editing a draft of this manuscript.

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Authors and Affiliations

  1. Digestive Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS – ISMETT, Via Tricomi 5, 90127, Palermo, Italy

    Antonino Granata, Michele Amata, Dario Ligresti, Alberto Martino, Ilaria Tarantino, Luca Barresi & Mario Traina

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  1. Antonino Granata
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Correspondence to Michele Amata.

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Antonino Granata, Michele Amata, Dario Ligresti, Alberto Martino, Ilaria Tarantino, Luca Barresi, and Mario Traina have no conflicts of interest or financial ties to disclose.

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Granata, A., Amata, M., Ligresti, D. et al. Endoscopic management of post-surgical GI wall defects with the overstitch endosuturing system: a single-center experience. Surg Endosc 34, 3805–3817 (2020). https://doi.org/10.1007/s00464-019-07145-7

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