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A novel grasp-and-loop closure method for defect closure after endoscopic full-thickness resection (with video)

Abstract

Background

Endoscopic full-thickness resection (EFTR) is a minimally invasive method for en bloc resection of gastrointestinal (GI) lesions originating from the muscularis propria layer. Successful closure of the wall defect is a critical step.

Objective

The aim of this study was to evaluate the feasibility and efficacy of a novel and simplified endoscopic grasp-and-loop (GAL) closure method using an endo-loop assisted with grasping forceps for defect closure.

Methods

From January 2015 to March 2016, 13 patients with submucosal tumors (SMTs) originating from the muscularis propria (MP) layer underwent EFTR and were enrolled in this study. After successful tumor resection, an endo-loop was anchored onto the circumferential margin of the gastric defect with grasping forceps assistance and tightened gently. Patient characteristics, tumor size, en bloc resection, and postoperative complications were evaluated.

Results

Of the 13 lesions in the stomach, two were located in the greater curvature of the mid-upper body, 11 were located in the fundus. The endoscopic GAL closure method was successfully performed after EFTR in all the 13 patients without laparoscopic assistance. The mean procedure time was 43.5 min (range 20–80 min), while the GAL closure procedure took a mean of 9.4 min (range 3–18 min). The mean resected lesion size was 1.5 cm (range 0.5–3.5 cm). Pathological diagnoses of these lesions were 11 gastrointestinal stromal tumors (GISTs) and two leiomyomas. No major adverse events occurred during or after the procedure. All the patients were discharged after a mean time of 2.4 days (range 1–4 days). No residual lesion or tumor recurrence was found during the follow-up period (median, 5 months; range, 1–15 months).

Conclusions

The endoscopic GAL closure method is feasible, effective, and safe for closing the gastric defect after EFTR in patients.

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Acknowledgements

The study was partially supported by Grants from the National Natural Science Foundation of China (No. 81570595), the City Key Program of Science and Technology of Shanghai (No. 14441901500), and the Natural Science Foundation of Xinjiang Province (No.2015211C118).

Author information

Correspondence to Mei-dong Xu.

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Disclosures

Doctors Jian-wei Hu, Lei Ge, Ping-Hong Zhou and Mei-Dong Xu have no conflicts of interest or financial ties to disclose.

Additional information

Jian-wei Hu and Lei Ge contributed equally to this work.

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Supplementary material 1 (WMV 70617 KB)

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Cite this article

Hu, J., Ge, L., Zhou, P. et al. A novel grasp-and-loop closure method for defect closure after endoscopic full-thickness resection (with video). Surg Endosc 31, 4275–4282 (2017) doi:10.1007/s00464-017-5473-5

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Keywords

  • Endoscopic full-thickness resection
  • Endoscopic surgical procedure
  • Gastric submucosal tumors
  • Gastric perforation
  • Endoscopic closure technique