Subscribe to RSS
DOI: 10.1055/a-2284-7334
Endoscopic outcomes using a novel through-the-scope tack and suture system for gastrointestinal defect closure: a systematic review and meta-analysis
Abstract
Background Closure of gastrointestinal defects can reduce postprocedural adverse events. Over-the-scope clips and an over-the-scope suturing system are widely available, yet their use may be limited by defect size, location, operator skill level, and need to reinsert the endoscope with the device attached. The introduction of a through-the-scope helix tack suture system (TTSS) allows for closure of large irregular defects using a gastroscope or colonoscope, without the need for endoscope withdrawal. Since its approval 3 years ago, only a handful of studies have explored outcomes using this novel device.
Methods Multiple databases were searched for studies looking at TTSS closure from inception until August 2023. The primary outcomes were the success of TTSS alone and TTSS with clips for complete defect closure. Secondary outcomes included complete closure based on procedure type (endoscopic mucosal resection [EMR], endoscopic submucosal dissection [ESD]) and adverse events.
Results Eight studies met the inclusion criteria (449 patients, mean defect size 34.3 mm). Complete defect closure rates for TTSS alone and TTSS with adjunctive clips were 77.2% (95%CI 66.4–85.3; I2=79%) and 95.2% (95%CI 90.3–97.7; I2=42.5%), respectively. Complete defect closure rates for EMR and ESD were 99.2% (95%CI 94.3–99.9; I2 = 0%) and 92.1% (95%CI 85–96; I2=0%), respectively. The adverse event rate was 5.4% (95%CI 2.7–10.3; I2=55%).
Conclusion TTSS is a novel device for closure of postprocedural defects, with relatively high technical and clinical success rates. Comparative studies of closure devices are needed.
Publication History
Received: 01 November 2023
Accepted after revision: 19 February 2024
Article published online:
22 March 2024
© 2024. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 Nomura T, Sugimoto S, Temma T. et al. Suturing techniques with endoscopic clips and special devices after endoscopic resection. Dig Endosc 2023; 35: 287-301
- 2 Hagel AF, Naegel A, Lindner AS. et al. Over-the-scope clip application yields a high rate of closure in gastrointestinal perforations and may reduce emergency surgery. J Gastrointest Surg 2012; 16: 2132-2138 DOI: 10.1007/s11605-012-1983-6. (PMID: 22903364)
- 3 Ge PS, Thompson CC. The use of the Overstitch to close perforations and fistulas. Gastrointest Endosc Clin N Am 2020; 30: 147-161 DOI: 10.1016/j.giec.2019.08.010. (PMID: 31739961)
- 4 Yu JX, Schulman AR. Complications of the use of the OverStitch endoscopic suturing system. Gastrointest Endosc Clin N Am 2020; 30: 187-195 DOI: 10.1016/j.giec.2019.09.005. (PMID: 31739964)
- 5 Hernandez A, Marya NB, Sawas T. et al. Gastrointestinal defect closure using a novel through-the-scope helix tack and suture device compared to endoscopic clips in a survival porcine model (with video). Endosc Int Open 2021; 9: E572-E577
- 6 Page MJ, McKenzie JE, Bossuyt PM. et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Syst Rev 2021; 10: 89 DOI: 10.1136/bmj.n71. (PMID: 33782057)
- 7 Covidence – Better systematic review management. Accessed August 12, 2013 at: https://www.covidence.org/
- 8 Qumseya BJ. Quality assessment for systematic reviews and meta-analyses of cohort studies. Gastrointest Endosc 2021; 93: 486-494.e1 DOI: 10.1016/j.gie.2020.10.007. (PMID: 33068610)
- 9 Higgins JPT, Thompson SG, Spiegelhalter DJ. A re-evaluation of random-effects meta-analysis. J R Stat Soc Ser A Stat Soc 2009; 172: 137-159 DOI: 10.1111/j.1467-985X.2008.00552.x. (PMID: 19381330)
- 10 Duval S, Tweedie R. Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 2000; 56: 455-463 DOI: 10.1111/j.0006-341x.2000.00455.x. (PMID: 10877304)
- 11 Agnihotri A, Mitsuhashi S, Holmes I. et al. Randomized trial of gastric and colorectal endoscopic submucosal dissection defect closure comparing a novel through-the-scope suturing system with an over-the-scope suturing system (with video). Gastrointest Endosc 2024; 99: 237-244.e1
- 12 Mahmoud T, Wong Kee Song LM, Stavropoulos SN. et al. Initial multicenter experience using a novel endoscopic tack and suture system for challenging GI defect closure and stent fixation (with video). Gastrointest Endosc 2022; 95: 373-382
- 13 Almario JA, Zhang LY, Cohen J. et al. Through-the-scope suture closure of nonampullary duodenal endoscopic mucosal resection defects: a retrospective multicenter cohort study. Endoscopy 2023; 55: 865-870 DOI: 10.1055/a-2077-4832. (PMID: 37207666)
- 14 Bi D, Zhang LY, Alqaisieh M. et al. Novel through-the-scope suture closure of colonic EMR defects (with video). Gastrointest Endosc 2023; 98: 122-129
- 15 Farha J, Ramberan H, Aihara H. et al. A novel through-the-scope helix tack-and-suture device for mucosal defect closure following colorectal endoscopic submucosal dissection: a multicenter study. Endoscopy 2023; 55: 571-577 DOI: 10.1055/a-1970-5528. (PMID: 36323330)
- 16 Zhang LY, Bejjani M, Ghandour B. et al. Through-the-scope suture closure of peroral endoscopic myotomy mucosal incision sites. Endoscopy 2023; 55: 186-191 DOI: 10.1055/a-1890-4917. (PMID: 35926541)
- 17 Khan HM, Brar TS, Hasan MK. et al. Prospective study on the efficacy of endoscopic through-the-scope tack and suture system for gastric peroral endoscopic myotomy mucosal incision site closure. Endosc Int Open 2023; 11: E187-E192 DOI: 10.1055/a-1978-6842. (PMID: 36845274)
- 18 Krishnan A, Shah-Khan SM, Hadi Y. et al. Endoscopic management of gastrointestinal wall defects, fistula closure, and stent fixation using through-the-scope tack and suture system. Endoscopy 2023; 55: 766-772 DOI: 10.1055/a-2019-3652. (PMID: 36693419)
- 19 Zhang LY, Bejjani M, Ghandour B. et al. Endoscopic through-the-scope suturing. VideoGIE 2022; 7: 46-51 DOI: 10.1016/j.vgie.2021.08.006. (PMID: 35059543)
- 20 Liu M, Zhang Y, Wang Y. et al. Effect of prophylactic closure on adverse events after colorectal endoscopic submucosal dissection: a meta-analysis. J Gastroenterol Hepatol 2020; 35: 1869-1877 DOI: 10.1111/jgh.15148. (PMID: 32542857)
- 21 Ullah S, Ali FS, Ostovan M. et al. Helix tack-and-suture device for mucosal defect closure following colorectal endoscopic submucosal dissection: is it ready for global adoption?. Endoscopy 2023; 55: 780-780 DOI: 10.1055/a-2046-5159. (PMID: 37499653)