A randomized trial comparing gastric and colorectal endoscopic submucosal dissection defect closure using novel through the scope suturing system with over-the-scope suturing system.
Journal
Gastrointestinal endoscopy
ISSN: 1097-6779
Titre abrégé: Gastrointest Endosc
Pays: United States
ID NLM: 0010505
Informations de publication
Date de publication:
01 Aug 2023
01 Aug 2023
Historique:
received:
30
01
2023
revised:
16
05
2023
accepted:
23
07
2023
medline:
4
8
2023
pubmed:
4
8
2023
entrez:
3
8
2023
Statut:
aheadofprint
Résumé
Mucosal closure adds time but reduces complications associated with endoscopic submucosal dissection (ESD). We aim to assess the closure time, technical success and cost effectiveness between a novel through-the-scope helix tack suture system (TTSS) and the over-the-scope suturing system (OTSS). In this single center, prospective, randomized trial, all patients having ESD with anticipated closure were randomized 1:1 to TTSS (study group) or OTSS (control group.) The primary outcome was the "closure time" (CT) and "overall closure time" (OCT, CT + setup time). Secondary outcomes were rates of technical success, adverse events and cost effectiveness. 40 patients were randomized (20 each to OTSS and TTSS). OTSS and TTSS groups were similar with respect to age, gender, proportion of colorectal polyps, proximal colon polyps and mean size of resected specimen in mm (40.9 vs 40.4). The mean CT was 18.4 min for OTSS and 23.3 min for TTSS (P=0.36). The mean OCT was 32 min for OTSS and 39.5 min for TTSS (P=0.36). Closure with primary device was successful in 17 (85%) cases with OTSS and 18 (90%) cases with TTSS (P=0.63). No closure related intraprocedural complications or delayed perforations were noted. Mean cost of closure was significantly lower in TTSS groups for lesions smaller than 35 mm (P=0.008). TTSS is not superior to OTSS with respect to closure time, technical and clinical success for closure of gastric and colorectal ESD defects. TTSS is more cost effective for closure of lesions smaller than 35 mm.
Sections du résumé
BACKGROUND AND AIMS
OBJECTIVE
Mucosal closure adds time but reduces complications associated with endoscopic submucosal dissection (ESD). We aim to assess the closure time, technical success and cost effectiveness between a novel through-the-scope helix tack suture system (TTSS) and the over-the-scope suturing system (OTSS).
METHODS
METHODS
In this single center, prospective, randomized trial, all patients having ESD with anticipated closure were randomized 1:1 to TTSS (study group) or OTSS (control group.) The primary outcome was the "closure time" (CT) and "overall closure time" (OCT, CT + setup time). Secondary outcomes were rates of technical success, adverse events and cost effectiveness.
RESULTS
RESULTS
40 patients were randomized (20 each to OTSS and TTSS). OTSS and TTSS groups were similar with respect to age, gender, proportion of colorectal polyps, proximal colon polyps and mean size of resected specimen in mm (40.9 vs 40.4). The mean CT was 18.4 min for OTSS and 23.3 min for TTSS (P=0.36). The mean OCT was 32 min for OTSS and 39.5 min for TTSS (P=0.36). Closure with primary device was successful in 17 (85%) cases with OTSS and 18 (90%) cases with TTSS (P=0.63). No closure related intraprocedural complications or delayed perforations were noted. Mean cost of closure was significantly lower in TTSS groups for lesions smaller than 35 mm (P=0.008).
CONCLUSION
CONCLUSIONS
TTSS is not superior to OTSS with respect to closure time, technical and clinical success for closure of gastric and colorectal ESD defects. TTSS is more cost effective for closure of lesions smaller than 35 mm.
Identifiants
pubmed: 37536633
pii: S0016-5107(23)02798-0
doi: 10.1016/j.gie.2023.07.046
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2023 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.