Aziz Muhammad, Haghbin Hossein, Gangwani Manesh Kumar, Beran Azizullah, Dahiya Dushyant Singh, Ali Hassam, Sohail Amir Humza, Lee-Smith Wade, Hamdani Syed Uzair, Kamal Faisal, Adler Douglas G
Division of Gastroenterology and Hepatology, University of Toledo, OH.
Division of Gastroenterology and Hepatology, East Carolina University, Greenville, NC.
J Clin Gastroenterol. 2025 Apr 1;59(4):361-368. doi: 10.1097/MCG.0000000000002019.
Recently, a through-the-scope suturing (TTSS) system has received FDA approval and has been evaluated for closing mucosal defects postintervention. We hereby performed a systematic review and pooled meta-analysis of available studies to assess the safety and efficacy of this intervention.
We queried the following databases through April 26, 2023: Embase, MEDLINE, Cochrane Central Register of Controlled Trials, and Web of Science Core Collection. Endoscopists utilizing TTSS for the following reasons were included: endoscopic mucosal resection, endoscopic submucosal dissection, peroral endoscopic myotomy, perforation, fistula closure, and/or stent fixation. The outcomes assessed were technical success, primary clinical success (closure of defect without additional intervention), and overall clinical success (closure of defect with/without additional intervention). Random effects model with the DerSimonian Laird approach was used to report event rates expressed as proportions with a 95% CI.
A total of 12 studies with 512 patients (mean age of 61.5 ± 18.4 y, 54.6% females) were included. The technical success rate was 96.0% (CI: 94.3%-97.7%). The primary clinical success rate was 74.8% (CI: 65.5%-84.1%). The overall clinical success rate was 95.4% (CI: 92.6-98.2%). Only 1 mortality case unrelated to intervention was reported.
The TTSS appears safe and effective for closing mucosal defects after therapeutic endoscopic interventions. Further cost-effective studies should be performed comparing with endoclips for use in clinical settings.
最近，一种经内镜缝合（TTSS）系统已获得美国食品药品监督管理局（FDA）批准，并已针对干预后闭合黏膜缺损进行了评估。我们在此对现有研究进行系统评价和汇总荟萃分析，以评估该干预措施的安全性和有效性。
我们检索了截至2023年4月26日的以下数据库：Embase、MEDLINE、Cochrane对照试验中央登记库和科学网核心合集。纳入因以下原因使用TTSS的内镜医师：内镜黏膜切除术、内镜黏膜下剥离术、经口内镜肌切开术、穿孔、瘘管闭合和/或支架固定。评估的结果包括技术成功、主要临床成功（无需额外干预即可闭合缺损）和总体临床成功（无论有无额外干预均可闭合缺损）。采用DerSimonian Laird方法的随机效应模型报告以比例表示的事件发生率，并给出95%置信区间。
共纳入12项研究，涉及512例患者（平均年龄61.5±18.4岁，女性占54.6%）。技术成功率为96.0%（置信区间：94.3%-97.7%）。主要临床成功率为74.8%（置信区间：65.5%-84.1%）。总体临床成功率为95.4%（置信区间：92.6%-98.2%）。仅报告了1例与干预无关的死亡病例。
TTSS在治疗性内镜干预后闭合黏膜缺损方面似乎安全有效。应进行进一步的成本效益研究，与临床环境中使用的内镜夹进行比较。
