Minireviews
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jul 27, 2021; 13(7): 645-654
Published online Jul 27, 2021. doi: 10.4240/wjgs.v13.i7.645
Closure techniques in exposed endoscopic full-thickness resection: Overview and future perspectives in the endoscopic suturing era
Antonino Granata, Alberto Martino, Dario Ligresti, Francesco Paolo Zito, Michele Amata, Giovanni Lombardi, Mario Traina
Antonino Granata, Dario Ligresti, Michele Amata, Mario Traina, Digestive Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS–ISMETT, Palermo 90127, Italy
Alberto Martino, Francesco Paolo Zito, Giovanni Lombardi, Department of Gastroenterology and Digestive Endoscopy, AORN “Antonio Cardarelli”, Napoli 80131, Italy
Author contributions: Granata A, Martino A and Ligresti D designed research and wrote, edited and finalized the text; Martino A, Zito FP and Amata M performed literature search and analyzed the data; Lombardi G and Traina M reviewed the paper for important intellectual content.
Conflict-of-interest statement: No conflict of interest to declare.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Alberto Martino, MD, Staff Physician, Department of Gastroenterology and Digestive Endoscopy, AORN “Antonio Cardarelli”, Via Antonio Cardarelli 9, Napoli 80131, Italy. alberto-martino@libero.it
Received: February 6, 2021
Peer-review started: February 6, 2021
First decision: March 16, 2021
Revised: March 29, 2021
Accepted: June 16, 2021
Article in press: June 16, 2021
Published online: July 27, 2021
Processing time: 166 Days and 19 Hours
Abstract

Exposed endoscopic full-thickness resection (EFTR) without laparoscopic assistance is a minimally invasive natural orifice transluminal endoscopic surgery technique that is emerging as a promising effective and safe alternative to surgery for the treatment of muscularis propria-originating gastric submucosal tumors. To date, various techniques have been used for the closure of the transmural post-EFTR defect, mainly consisting in clip- and endoloop-assisted closure methods. However, the recent advent of dedicated tools capable of providing full-thickness defect suture could further improve the efficacy and safety of the exposed EFTR procedure. The aim of our review was to evaluate the efficacy and safety of the different closure methods adopted in gastric-exposed EFTR without laparoscopic assistance, also considering the recent advent of flexible endoscopic suturing.

Keywords: Endoscopic full-thickness resection; Exposed endoscopic full-thickness resection; Full-thickness resection; Natural orifice transluminal endoscopic surgery; Endoscopic surgery; Endoscopic suturing

Core Tip: Exposed endoscopic full-thickness resection (EFTR) without laparoscopic assistance is a natural orifice transluminal endoscopic surgery technique that is emerging as a promising alternative to surgery for the treatment of muscularis propria-originating gastric submucosal tumors. To date, transmural post-EFTR defect closure has been achieved mainly by means of hemostatic devices, such as clips only or clips combined with endoloops. However, the recent advent of dedicated tools capable of providing full-thickness defect suture could further improve the efficacy and safety of the exposed EFTR procedure. Our review aimed to evaluate the efficacy and safety of the different closure techniques adopted in gastric-exposed EFTR without laparoscopic assistance, also considering the recent advent of flexible endoscopic suturing.