Department of Gastroenterology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China.
World J Gastroenterol. 2023 Jan 28;29(4):731-743. doi: 10.3748/wjg.v29.i4.731.
Large or transmural defects induced by gastrointestinal endoscopic manipulations are difficult to close, although complete closure is recommended for better recovery. Endoscopic purse-string assisted suturing (EPSS) has been used in clinical practice and has proven to be an effective and safe technique for the closure of large mucosal defects. However, details regarding the efficacy of endoscopic pre-purse-string suture (P-EPSS) are unknown, especially that it offers several advantages over conventional EPSS (C-EPSS).
To elucidate the outcomes of EPSS-assisted closure in different clinical situations, and evaluate the efficacy of P-EPSS.
This retrospective observational study included a total of 180 patients who underwent closure assisted by P-EPSS ( = 63) or C-EPSS ( = 117) between July 2014 and June 2020. The P-EPSS and C-EPSS groups were compared and the intergroup differences in aspects such as the lesion size, location, and mor-phology, incidence of complete closure, intraoperative perforation, and delayed adverse events were evaluated. Data on the features and clinical course of cases with adverse events were collected for further analysis.
Patients with lesion size larger than 3 cm, lesions located at the fundus of stomach, or submucosal tumors originating from the deep mucosa were more likely to undergo P-EPSS-assisted closure. The P-EPSS group showed a sign-ificantly higher proportion of intraoperative perforation (56% 17%) and a much shorter procedure time (9.06 ± 6.14 min 14.84 ± 7.25 min). Among adverse events, the incidence of delayed perforation (5% 4%; = 0.82) and delayed bleeding (3% 4%; = 0.96) did not differ significantly between the groups. Multivariate analysis revealed that lesions with incomplete closure [odds ratio (OR) = 21.33; 95% confidence interval (CI): 5.45-83.45; < 0.01] or size greater than 3 cm (OR = 3.14; 95%CI: 1.08-9.18; = 0.039) showed a statistical tendency to result in an increase in delayed adverse events.
The present study revealed that EPSS could achieve secure complete closure of mucosal defect. P-EPSS could shorten the procedure and yield complete closure of mucosal defects. Rather than closure-type selection, incomplete closure or lesion size larger than 3 cm were associated with worse outcomes.
尽管完全闭合有利于更好的恢复，但胃肠道内镜操作引起的大或透壁性缺陷很难闭合。内镜荷包缝合辅助缝合（EPSS）已在临床实践中使用，并已被证明是闭合大黏膜缺损的有效且安全的技术。然而，关于内镜预荷包缝合（P-EPSS）疗效的详细信息尚不清楚，特别是它比传统 EPSS（C-EPSS）具有多项优势。
阐明 EPSS 辅助闭合在不同临床情况下的结果，并评估 P-EPSS 的疗效。
本回顾性观察性研究共纳入 2014 年 7 月至 2020 年 6 月期间接受 P-EPSS（n=63）或 C-EPSS（n=117）辅助闭合的 180 例患者。比较 P-EPSS 组和 C-EPSS 组，评估两组在病变大小、位置和形态、完全闭合率、术中穿孔率和迟发性不良事件发生率等方面的差异。收集不良事件病例的特征和临床经过数据进行进一步分析。
病变大小大于 3cm、病变位于胃底或起源于黏膜深层的黏膜下肿瘤的患者更倾向于接受 P-EPSS 辅助闭合。P-EPSS 组术中穿孔率（56%[17%]比 32%[24%]）更高，手术时间（9.06±6.14min 比 14.84±7.25min）更短。不良事件中，迟发性穿孔（5%[4%]比 3%[4%]）和迟发性出血（3%[4%]比 3%[4%]）发生率差异无统计学意义（=0.82）。多因素分析显示，未完全闭合的病变[比值比（OR）=21.33；95%置信区间（CI）：5.45-83.45；<0.01]或病变大小大于 3cm（OR=3.14；95%CI：1.08-9.18；=0.039）与迟发性不良事件增加有统计学趋势。
本研究表明 EPSS 可安全地完全闭合黏膜缺损。P-EPSS 可缩短手术时间并使黏膜缺损完全闭合。与闭合类型选择相比，不完全闭合或病变大小大于 3cm 与不良结局相关。
