Feasibility and efficacy of endoscopic purse-string suture-assisted closure for mucosal defects induced by endoscopic manipulations

doi:10.3748/wjg.v29.i4.731

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Jan 28, 2023 (publication date) through Feb 24, 2025

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Gastroenterol. Jan 28, 2023; 29(4): 731-743
Published online Jan 28, 2023. doi: 10.3748/wjg.v29.i4.731

Table 1 Predictors for closure of mucosal defects using endoscopic pre-purse-string suture method

Predictors	P-EPSS/C-EPSS (n)	Odds ratio	95%CI	P value
Location (%)
Fundus	35/44	2.07	1.11-3.86	0.03¹
Others	28/73	1
Defect size
≥ 3 cm	44/8	31.55	12.86-77.40	< 0.01¹
< 3 cm	19/109	1
Morphology
Deep SMT	36/40	2.57	1.37-4.81	< 0.01¹
Others	27/77	1

¹Statistically significant.

P-EPSS: Endoscopic pre-purse-string suture; C-EPSS: Conventional endoscopic purse-string suture; SMT: Submucosal tumor; CI: Confidence interval.

Table 2 Outcomes of purse-string suture according to different closure type

Outcomes	Total	P-EPSS	C-EPSS	P value
Complete closure, n (%)	169 (94)	59 (94)	110 (94)	0.80
Intraoperative perforation, n (%)	55 (31)	35 (56)	20 (17)	< 0.01¹
Delayed adverse events, n (%)
Delayed perforation	8 (4)	3 (5)	5 (4)	0.82
Delayed bleeding	7 (4)	2 (3)	5 (4)	0.96
Operation time (min), mean ± SD	12.82 ± 7.83	9.06 ± 6.14	14.84 ± 7.25	< 0.01¹
Fasting period (d), median (range)	2 (1-5)	2 (1-5)	2 (1-5)	0.88
Hospital stay (d), median (range)	6 (4-11)	6 (4-10)	6 (4-11)	0.87
Total cost (dollars), mean ± SD	2481 ± 445	2448 ± 365	2498 ± 418	0.47

¹Statistically significant.

SD: Standard deviation; P-EPSS: Endoscopic pre-purse-string suture; C-EPSS: Conventional endoscopic purse-string suture.

Table 3 Baseline characteristics of the cases in this study

Patients detail	Total (n = 180)	P-EPSS (n = 63)	C-EPSS (n = 117)	P value
Age (yr), mean (range)	60 (38-78)	62 (42-76)	60 (38-78)	0.19
Sex, n (%)				0.75
Female	112 (62)	38 (60)	74 (63)
Male	68 (38)	25 (40)	43 (37)
Manipulation, n (%)				0.40
EFTR	36 (20)	15 (24)	21 (18)
ESE	32 (18)	13 (21)	19 (16)
ESD	112 (62)	35 (55)	77 (66)
Location, n(%)				0.10
Stomach
Fundus	79 (44)	35 (56)	44 (38)
Body	45 (25)	11 (17)	34 (29)
Antrum	22 (12)	8 (13)	14 (12)
Colon and rectum	34 (19)	9 (14)	25 (21)
Defect size (cm), mean ± SD	2.89 ± 1.46	3.6 ± 1.13	2.5 ± 0.68	0.02¹
Morphology, n(%)				0.01¹
Deep SMT	76 (42)	36 (57)	40 (34)
Superficial SMT	55 (31)	15 (24)	40 (34)
Precancerous lesions	49 (27)	12 (19)	37 (32)

¹Statistically significant.

SD: Standard deviation; SMT: Submucosal tumor; ESD: Endoscopic submucosal dissection; ESE: Endoscopic submucosal excavation; EFTR: Endoscopic full-thickness resection; P-EPSS: Endoscopic pre-purse-string suture; C-EPSS: Conventional endoscopic purse-string suture.

Table 4 Clinical features of 15 patients with adverse events

Age (yr)	Sex	Manipulation	Location	Size (cm)	Morphology	Closure type	Complete closure	Intraoperative perforation	Procedure time (min)	Delayed adverse events	Discharge (d)	Total cost (dollars)
60	Male	ESD	Fundus	3	Superficial SMT	C-EPSS	Yes	Yes	20	Delayed bleeding	10	2522
58	Male	EFTR	Fundus	4	Deep SMT	P-EPSS	Yes	Yes	15	Delayed perforation	11	2835
75	Female	ESD	Rectum	2.5	Superficial SMT	C-EPSS	No	No	22	Delayed bleeding	9	2710
56	Female	ESE	Fundus	3.5	Deep SMT	P-EPSS	No	No	24	Delayed perforation	6	2238
74	Female	ESD	Antrum	2	Precancerous lesion	C-EPSS	Yes	No	20	Delayed bleeding	7	2489
68	Male	ESD	Body	2.5	Deep SMT	C-EPSS	No	No	10	Delayed perforation	8	2470
58	Male	EFTR	Fundus	4	Superficial SMT	P-EPSS	Yes	Yes	15	Delayed perforation	7	2556
62	Male	ESE	Rectum	3.5	Precancerous lesion	C-EPSS	No	No	20	Delayed perforation	10	2884
63	Female	ESD	Antrum	3.5	Precancerous lesion	C-EPSS	No	No	12	Delayed bleeding	8	2690
71	Male	ESD	Rectum	2.5	Precancerous lesion	C-EPSS	Yes	No	14	Delayed perforation	6	2729
69	Male	ESE	Colon	2	Precancerous lesion	C-EPSS	Yes	No	18	Delayed perforation	8	2577
76	Male	EFTR	Fundus	3.5	Deep SMT	P-EPSS	Yes	Yes	25	Delayed perforation	8	2306
56	Female	ESD	Fundus	2.5	Superficial SMT	C-EPSS	Yes	Yes	10	Delayed bleeding	7	2423
61	Male	EFTR	Fundus	2.5	Deep SMT	C-EPSS	No	Yes	15	Delayed perforation	6	2789
70	Female	EFTR	Body	3.5	Superficial SMT	P-EPSS	Yes	Yes	20	Delayed bleeding	7	2687

SMT: Submucosal tumor; P-EPSS: Endoscopic pre-purse-string suture; C-EPSS: Conventional endoscopic purse-string suture; ESD: Endoscopic submucosal dissection; ESE: Endoscopic submucosal excavation; EFTR: Endoscopic full-thickness resection.

Table 5 Risk factors for delayed adverse events

Factors	Total (AE)	Odds ratio	95%CI	P value
Closure of defects
Incomplete	11 (6)	21.33	5.45-83.45	< 0.01¹
Complete	169 (9)	1
Location (%)
Fundus	79 (7)	1.13	0.39-3.26	0.82
Others	101 (8)	1
Defect size
≥ 3 cm	52 (8)	3.14	1.08-9.18	0.039¹
< 3 cm	128 (7)	1
Morphology
Deep SMT	76 (6)	0.90	0.31-2.66	0.86
Others (superficial SMT and precancerous lesion)	104 (9)	1
Closure type
P-EPSS	63 (5)	0.92	0.30-2.83	1.00
C-EPSS	117 (10)	1
Intraoperative perforation
Yes	55 (7)	2.13	0.73-6.21	0.24
No	125 (8)	1
Dissection method
EFTR	36 (5)	2.16	0.69-6.78	0.19
Others (ESD and ESE)	144 (10)	1

¹Statistically significant.

SMT: Submucosal tumor; P-EPSS: Endoscopic pre-purse-string suture; C-EPSS: Conventional endoscopic purse-string suture; AE: Adverse event; ESD: Endoscopic submucosal dissection; ESE: Endoscopic submucosal excavation; EFTR: Endoscopic full-thickness resection.

Citation: Li MM, Zhang Y, Sun F, Huai MX, Zhang FY, Qu CY, Shen F, Li ZH, Xu LM. Feasibility and efficacy of endoscopic purse-string suture-assisted closure for mucosal defects induced by endoscopic manipulations. World J Gastroenterol 2023; 29(4): 731-743
URL: https://www.wjgnet.com/1007-9327/full/v29/i4/731.htm
DOI: https://dx.doi.org/10.3748/wjg.v29.i4.731