The prepurse-string suture technique for gastric defect after endoscopic full-thickness resection (with video)

Endoscopic full-thickness resection (EFTR) is the main treatment for gastric tumors originating from the muscularis propria or gastric extra-luminal growth tumors. Successful closure of the gastric wall defect is a critical step during EFTR. The aim of this retrospective study was to evaluate the feasibility and safety of the endoscopic prepurse-string suture (p-EPSS) technique using an endoloop and several metallic clips during EFTR to close the perforation. Twenty-five patients with gastric tumors originated from the muscularis propria or with gastric extra-luminal growth tumors who received EFTR were analyzed at the Renmin Hospital of Wuhan University from June 2016 to May 2017. Patient characteristics, tumor characteristics, operation time length, and postoperative complications were evaluated in all patients. All the 25 patients underwent a successful EFTR. Complete closure of gastric defects was also achieved. The mean operation time length was 31 ± 14 minutes. The mean maximum size of tumor of was 1.7 ± 1.0 cm (range 0.5–4.5 cm). No severe postoperative complications occurred, such as massive bleeding, gastric leak, peritonitis, or abdominal abscess. No patient needed surgical intervention. Wounds were well healed 1 month after EFTR. No tumor metastasis and recurrence were observed during the follow-up period (median, 7 months). The p-EPSS technique using endoloop and several sterile repositionable hemostasis clips is safe and feasible for closing gastric perforation during EFTR.