Closure strength of endoscopic hand-suturing in ex vivo porcine gastric ESD defect models: an exploratory animal study

Abstract

Background: Endoscopic hand-suturing (EHS) has been used to close gastrointestinal defects following endoscopic submucosal resection (ESD), but its closure strength needs further evaluation. This exploratory animal study aimed to compare the closure strength of EHS and titanium clips in ex vivo porcine gastric ESD defect models.

Methods: Fifteen porcine stomachs were used to create ESD defect models, each featuring a 2-3-cm defect in the gastric body and another in the antrum. Defects were randomly assigned to three groups: EHS group (Group A), dense clipping group (Group B), and loose clipping group (Group C). Under endoscopy, Group A defects were sutured with 4 stitches, Group B with 7 clips, and Group C with 4 clips. The primary outcome measures were overall closure strength and closure strength per unit length, measured with a digital spring scale. Differences among groups were analyzed with the Kruskal-Wallis H test.

Result: All 30 defects were successfully closed endoscopically. Group A achieved significantly higher overall closure strength [1.06 kg (0.96 kg, 1.22 kg)] compared to Group B [0.27 kg (0.19 kg, 0.31 kg), P = 0.026] and Group C [0.11 kg (0.09 kg, 0.15 kg), P < 0.001]. For the closure strength per unit length, Group A [0.33 kg (0.27 kg, 0.35 kg)] also outperformed Group B [0.08 kg (0.06 kg, 0.10 kg), P = 0.023] and Group C [0.04 kg (0.03 kg, 0.04 kg), P < 0.001].

Conclusion: EHS can provide superior closure strength for ex vivo gastric ESD defects compared to simple titanium clips.

Keywords: Closure strength; Endoscopic hand-suturing; Endoscopic submucosal dissection; Titanium clip.