Skip to main content

Advertisement

SpringerLink
Log in

Efficacy and feasibility of OverStitch suturing of leaks in the upper gastrointestinal tract

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Management of upper gastrointestinal leaks is challenging. A new potential treatment option for this complication is endoscopic suturing with the OverStitch system (Apollo Endosurgery, Texas, USA), which is today mainly used for endoscopic sleeve gastroplasty. The aim of this study was to analyze the efficacy and feasibility of this new treatment option in patients with leaks in the upper gastrointestinal tract.

Methods

We performed a retrospective, single-center study of all patients who underwent endoscopic suturing with OverStitch of leaks in the upper gastrointestinal tract.

Results

Endoscopic suturing was performed on 13 patients (mean age, 59.62 ± 16.29 years; mean leak size, 22.31 ± 22.6 mm) over a period of 8 months. Postoperative leaks were detected in 10 patients (76.9%) after foregut surgery. Interventional success was achieved in all endoscopic attempts (n = 16, 100%) with a mean closure time of 28.0 ± 12.36 min per patient. Follow-up technical success rate for each suture was (n = 8, 50.0%). Clinical success, including repeated suture attempts was achieved in 8 of the 13 patients (61.5%). These 8 patients had not received prior treatment for the leak. No immediate or delayed serious complications occurred as a result of OverStitch. The mean follow-up was 95 ± 91.07 days.

Conclusions

Endoscopic suturing with OverStitch for leaks in the upper gastrointestinal tract is feasible and effective in patients who have not received prior treatment. This minimally invasive technique seems to be a promising option especially for patients with large leaks and significant comorbidities.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

SC:

Seung-Hun Chon

UT:

Ulrich Toex

ESD:

Endoscopic mucosal dissection

EVT:

Endoscopic vacuum therapy

OTSC:

Over the scope clip

EMR:

Endoscopic mucosal resection

SEMS:

Self-expanding metal stent

NGT:

Nasogastric tube

AT:

Antimicrobial therapy

D:

CT-Guided Drain

References

  1. Peery AF, Dellon ES, Lund J, Crockett SD, McGowan CE, Bulsiewicz WJ, Gangarosa LM, Thiny MT, Stizenberg K, Morgan DR, Ringel Y, Kim HP, Dibonaventura MD, Carroll CF, Allen JK, Cook SF, Sandler RS, Kappelman MD, Shaheen NJ (2012) Burden of gastrointestinal disease in the United States: 2012 update. Gastroenterology 143:1179–1187.e3

    Article  Google Scholar 

  2. Angrisani L, Santonicola A, Iovino P, Vitiello A, Higa K, Himpens J, Buchwald H, Scopinaro N (2018) IFSO Worldwide Survey 2016: primary, Endoluminal, and Revisional Procedures. Obes Surg 28:3783–3794

    Article  Google Scholar 

  3. Chen Z, Ren Y, Du XL, Yang J, Shen Y, Li S, Wu Y, Lv M, Dong D, Li E, Li W, Liu P, Yang J, Yi M (2017) Incidence and survival differences in esophageal cancer among ethnic groups in the United States. Oncotarget 8:47037–47051

    Article  Google Scholar 

  4. Lang H, Piso P, Stukenborg C, Raab R, Jähne J (2000) Management and results of proximal anastomotic leaks in a series of 1114 total gastrectomies for gastric carcinoma. Eur J Surg Oncol 26:168–171

    Article  CAS  Google Scholar 

  5. Junemann-Ramirez M, Awan MY, Khan ZM, Rahamim JS (2005) Anastomotic leakage post-esophagogastrectomy for esophageal carcinoma: retrospective analysis of predictive factors, management and influence on longterm survival in a high volume centre. Eur J Cardio-Thoracic Surg 27:3–7

    Article  CAS  Google Scholar 

  6. Low DE, Kuppusamy MK, Alderson D, Cecconello I, Chang AC, Darling G, Davies A, D’Journo XB, Gisbertz SS, Griffin SM, Hardwick R, Hoelscher A, Hofstetter W, Jobe B, Kitagawa Y, Law S, Mariette C, Maynard N, Morse CR, Nafteux P, Pera M, Pramesh CS, Puig S, Reynolds JV, Schroeder W, Smithers M, Wijnhoven BPL (2017) Benchmarking complications associated with esophagectomy. Ann Surg. https://doi.org/10.1097/SLA.0000000000002611

    Article  PubMed  Google Scholar 

  7. Dent B, Griffin SM, Jones R, Wahed S, Immanuel A, Hayes N (2016) Management and outcomes of anastomotic leaks after oesophagectomy. Br J Surg 103:1033–1038

    Article  CAS  Google Scholar 

  8. Grimminger PP, Goense L, Gockel I, Bergeat D, Bertheuil N, Chandramohan SM, Chen KN, Chon SH, Denis C, Goh KL, Gronnier C, Liu JF, Meunier B, Nafteux P, Pirchi ED, Schiesser M, Thieme R, Wu A, Wu PC, Buttar N, Chang AC (2018) Diagnosis, assessment, and management of surgical complications following esophagectomy. Ann N Y Acad Sci. https://doi.org/10.1111/nyas.13920

    Article  PubMed  Google Scholar 

  9. Hölscher AH, Vallböhmer D, Brabender J (2006) The prevention and management of perioperative complications. Best Pract Res Clin Gastroenterol 20:907–923

    Article  Google Scholar 

  10. Bège T, Emungania O, Vitton V, Ah-Soune P, Nocca D, Noël P, Bradjanian S, Berdah SV, Brunet C, Grimaud JC, Barthet M (2011) An endoscopic strategy for management of anastomotic complications from bariatric surgery: a prospective study. Gastrointest Endosc 73:238–244

    Article  Google Scholar 

  11. Raju GS (2007) Endoscopic management of gastrointestinal leaks. Gastrointest Endosc Clin N Am 17:487–503

    Article  CAS  Google Scholar 

  12. Nguyen NT, Rudersdorf PD, Smith BR, Reavis K, Nguyen XMT, Stamos MJ (2011) Management of gastrointestinal leaks after minimally invasive esophagectomy: conventional treatments vs. endoscopic stenting. J Gastrointest Surg 15:1952–1960

    Article  Google Scholar 

  13. Bludau M, Fuchs HF, Herbold T, Maus MKHMKH, Alakus H, Popp F, Leers JM, Bruns CJ, Hölscher AH, Schröder W, Chon SH (2017) Results of endoscopic vacuum-assisted closure device for treatment of upper GI leaks. Surg Endosc 32:149–150

    Google Scholar 

  14. Verlaan T, Voermans RP, Van Berge Henegouwen MI, Bemelman WA, Fockens P (2015) Endoscopic closure of acute perforations of the GI tract: a systematic review of the literature. Gastrointest Endosc 82:618–628

    Article  Google Scholar 

  15. Paspatis GA, Dumonceau JM, Barthet M, Meisner S, Repici A, Saunders BP, Vezakis A, Gonzalez JM, Turino SY, Tsiamoulos ZP, Fockens P, Hassan C (2014) Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 46:693–711

    Article  Google Scholar 

  16. Sanders MK, Malick J, Fasanella KE, Voermans RP, Le Moine O, von Renteln D, Ponchon T, Giovannini M, Bruno MJ, Weusten BLAM, Seewald S, Costamagna G, Deprez P, Fockens P, Voermans RP, Verlaan T, Bergman JJGHM, Rauws EA, Fockens P, Giovannini M, Galasso D, Larghi A, Costamagna G, Deprez P, Le Moine O, Devière J, Neuhaus HN, Schumacher B, Bruno MJ, Seewald S, Ponchon T, Weusten BLAM, von Renteln D, Rösch T et al (2012) Efficacy of endoscopic closure of acute perforations of the gastrointestinal tract. Clin Gastroenterol Hepatol 10:603–608

    Article  Google Scholar 

  17. Conway NE, Swanström LL (2015) Endoluminal flexible endoscopic suturing for minimally invasive therapies. Gastrointest Endosc 81:262–269.e19

    Article  Google Scholar 

  18. Muniraj T, Aslanian HR (2017) The use of OverStitch for the treatment of intestinal perforation, fistulas and leaks. Gastrointest Interv. 6:151–156

    Article  Google Scholar 

  19. Stavropoulos SN, Modayil R, Friedel D (2015) Current applications of endoscopic suturing. World J Gastrointest Endosc 7:777

    Article  Google Scholar 

  20. Abu Dayyeh BK, Rajan E, Gostout CJ (2013) Endoscopic sleeve gastroplasty: a potential endoscopic alternative to surgical sleeve gastrectomy for treatment of obesity. Gastrointest Endosc 78:530–535

    Article  Google Scholar 

  21. Vargas EJ, Bazerbachi F, Rizk M, Rustagi T, Acosta A, Wilson EB, Wilson T, Neto MG, Zundel N, Mundi MS, Collazo-Clavell ML, Meera S, Abu-Lebdeh HS, Lorentz PA, Grothe KB, Clark MM, Kellogg TA, McKenzie TJ, Kendrick ML, Topazian MD, Gostout CJ, Abu Dayyeh BK (2018) Transoral outlet reduction with full thickness endoscopic suturing for weight regain after gastric bypass: a large multicenter international experience and meta-analysis. Surg Endosc Other Interv Tech 32:252–259

    Article  Google Scholar 

  22. Fujii LL, Bonin EA, Baron TH, Gostout CJ, Wong Kee Song LM (2013) Utility of an endoscopic suturing system for prevention of covered luminal stent migration in the upper GI tract. Gastrointest Endosc 78:787–793

    Article  Google Scholar 

  23. Kantsevoy SV, Bitner M, Mitrakov AA, Thuluvath PJ (2014) Endoscopic suturing closure of large mucosal defects after endoscopic submucosal dissection is technically feasible, fast, and eliminates the need for hospitalization (with videos). Gastrointest Endosc 79:503–507

    Article  Google Scholar 

  24. Chon SH, Toex U, Plum PS, Fuchs C, Kleinert R, Bruns C, Goeser T (2018) Successful closure of a gastropulmonary fistula after esophagectomy using the Apollo Overstitch and endoscopic vacuum therapy. Endoscopy 50:E149–E150

    Article  Google Scholar 

  25. Henderson JB, Sorser SA, Atia AN, Catalano MF (2014) Repair of esophageal perforations using a novel endoscopic suturing system. Gastrointest Endosc 80:535–537

    Article  Google Scholar 

  26. Jirapinyo P, Watson RR, Thompson CC (2012) Use of a novel endoscopic suturing device to treat recalcitrant marginal ulceration (with video). Gastrointest Endosc 76:435–439

    Article  Google Scholar 

  27. Bonin EA, Wong Kee Song LM, Gostout ZS, Bingener J, Gostout CJ (2012) Closure of a persistent esophagopleural fistula assisted by a novel endoscopic suturing system. Endoscopy 44:8–9

    Article  Google Scholar 

  28. Plum PS, Herbold T, Berlth F, Christ H, Alakus H, Bludau M, Chang DH, Bruns CJ, Hölscher AH, Chon SH (2019) Outcome of self-expanding metal stents in the treatment of anastomotic leaks after Ivor Lewis esophagectomy. World J Surg 43:862–869

    Article  Google Scholar 

  29. Mukewar S, Kumar N, Catalano M, Thompson C, Abidi W, Harmsen W, Enders F, Gostout C (2016) Safety and efficacy of fistula closure by endoscopic suturing: a multi-center study. Endoscopy 48:1023–1028

    Article  Google Scholar 

  30. Sharaiha RZ, Kumta NA, Defilippis EM, Dimaio CJ, Gonzalez S, Gonda T, Rogart J, Siddiqui A, Berg PS, Samuels P, Miller L, Khashab M, Saxena P, Gaidhane MR, Tyberg A, Teixeira J, Widmer J, Kedia P, Loren D, Kahaleh M, Sethi A (2016) A large multicenter experience with endoscopic suturing for management of gastrointestinal defects and stent anchorage in 122 patients: a retrospective review. J. Clin. Gastroenterol. 50:388–392

    PubMed  Google Scholar 

  31. Tsai C, Kessler U, Steffen R, Merki H, Zehetner J (2019) Endoscopic closure of gastro-gastric fistula after gastric bypass: a technically feasible procedure but associated with low success rate. Obes Surg 1:23–27

    Article  Google Scholar 

  32. Enoch S, Leaper DJ (2005) Basic science of wound healing. Surgery 23:37–42

    Google Scholar 

  33. Gurtner GC, Werner S, Barrandon Y, Longaker MT (2008) Wound repair and regeneration. Nature 453:314–321

    Article  CAS  Google Scholar 

  34. Halvax P, Diana M, Nagao Y, Marescaux J, Swanström L (2017) Experimental evaluation of the optimal suture pattern with a flexible endoscopic suturing system. Surg Innov 24:201–204

    Article  Google Scholar 

  35. Aryaie AH, Singer JL, Fayezizadeh M, Lash J, Marks JM (2017) Efficacy of endoscopic management of leak after foregut surgery with endoscopic covered self-expanding metal stents (SEMS). Surg Endosc Other Interv Tech 31:612–617

    Article  Google Scholar 

  36. Lichtenstein DR, Jagannath S, Baron TH, Anderson MA, Banerjee S, Dominitz JA, Fanelli RD, Gan SI, Harrison ME, Ikenberry SO, Shen B, Stewart L, Khan K, Vargo JJ (2008) Sedation and anesthesia in GI endoscopy. Gastrointest Endosc 68:815–826

    Article  Google Scholar 

Download references

Acknowledgements

We would like to thank all the nurses at our interdisciplinary endoscopy unit for their excellent technical assistance and the medical students Julia Buttermann and Vito Lagdoka for their help to collect the data. We thank Lisa-Marie Teubler for proofreading.

Funding

None.

Author information

Authors and Affiliations

  1. Department of General, Visceral, Cancer and Transplant Surgery, University Hospital of Cologne, Cologne, Germany

    Seung-Hun Chon, Patrick Sven Plum, Robert Kleinert & Christiane Josephine Bruns

  2. Department of Gastroenterology and Hepatology, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany

    Seung-Hun Chon, Ulrich Toex & Tobias Goeser

  3. Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg University, Mainz, Germany

    Felix Berlth

  4. Interdisciplinary Endoscopy Unit, Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany

    Seung-Hun Chon

Authors
  1. Seung-Hun Chon
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ulrich Toex
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Patrick Sven Plum
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Robert Kleinert
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Christiane Josephine Bruns
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tobias Goeser
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Felix Berlth
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

S-HC: conception and design, acquisition of data, analysis of data, interpretation of data, drafting the work, and final approval of the manuscript. UT: analysis of data, interpretation of data, revising the work, and final approval of the manuscript. PSP: interpretation of data, revising the work, and final approval of the manuscript. RK: interpretation of data, revising the work, and final approval of the manuscript. CJB: design of the work, revising the work, and final approval of the manuscript. TG: design of the work, revising the work, and final approval of the manuscript. FB: conception and design, analysis of data, interpretation of data, drafting the work, and final approval of the manuscript.

Corresponding author

Correspondence to Seung-Hun Chon.

Ethics declarations

Disclosures

Drs. Seung-Hun Chon, Ulrich Toex, Patrick Sven Plum, Robert Kleinert, Christiane Josphine Bruns, Tobias Goeser, and Felix Berlth have no conflicts of interest or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (AVI 29755 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chon, SH., Toex, U., Plum, P.S. et al. Efficacy and feasibility of OverStitch suturing of leaks in the upper gastrointestinal tract. Surg Endosc 34, 3861–3869 (2020). https://doi.org/10.1007/s00464-019-07152-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-019-07152-8

Keywords

Search

Navigation