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Application of novel endoloops to close the defects resulted from endoscopic full-thickness resection with single-channel gastroscope: a multicenter study

Abstract

Background

The key step of the endoscopic full-thickness resection (EFTR) procedure is the successful closure of any gastric wall defect which ultimately avoids surgical intervention. This report presents a new method of closing large gastric defects left after EFTR, using metallic clips and novel endoloops by means of single-channel endoscope.

Methods

We retrospectively analyzed 68 patients who were treated for gastric fundus gastrointestinal stromal tumors originating from the muscularis propria layer at four institutes between April 2014 and February 2015 and consequently underwent EFTR. The large gastric post-EFTR defects were completely closed with metallic clips and novel endoloops using single-channel endoscope, and all the patients were discharged with subsequent endoscopic and clinical follow-up. Patient characteristics, tumor size, en bloc resection rate, closure operation time, and postoperative adverse events were evaluated.

Results

EFTR was successfully performed on 68 patients [41 male (60 %), 27 female (40 %); median age 61 years, range 38–73], and the en bloc resection rate was 100 %. Complete closure of all the gastric post-EFTR defects was achieved (success rate 100 %). The mean closure operation time was 13 min (range 9–21 min). The mean maximum size of the lesions was 2.6 cm (range 2.0–3.5 cm). One Mallory–Weiss syndrome and one delayed bleeding were resolved with nonsurgical treatment. The wounds were healed in all cases 1 month after the procedure.

Conclusions

The use of metallic clips and novel endoloops with single-channel endoscope is a relatively safe, easy, and feasible method for repairing large gastric post-EFTR defects.

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Acknowledgments

The authors would like to thank the patients with gastric stromal tumors for their participation and cooperation. This study was supported in part by the grants from Natural Science Foundation of Jiangsu Province Education Department (14KJB320014).

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Correspondence to Rui Li.

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Disclosures

Dongtao Shi, Rui Li, Weichang Chen, Deqing Zhang, Lei Zhang, Rui Guo, Ping Yao and Xudong Wu have no conflict of interest.

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Shi, D., Li, R., Chen, W. et al. Application of novel endoloops to close the defects resulted from endoscopic full-thickness resection with single-channel gastroscope: a multicenter study. Surg Endosc 31, 837–842 (2017). https://doi.org/10.1007/s00464-016-5041-4

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Keywords

  • Defect closure
  • Endoloop
  • Endoscopic full-thickness resection
  • Gastrointestinal stromal tumors