Endoscopic Suturing Systems

Fig. 6.1

OverStitch endoscopic suturing device consists of a curved suturing arm on end plate (1) accentuated by a handle (2) and a needle holder (3)

OverStitch endoscopic suturing device has been successfully used for numerous clinical indications:

Closure of GI tract fistulas [21, 22]
Fixation of internal stents to prevent stent migration (Fig. 6.2) [23–25]

Fig. 6.2

Fixation of internal stent with OverStitch endoscopic suturing device. (a) A fully covered self-expending metal stent is placed proximal in the esophagus. (b) OverStitch endoscopic suturing device has been advanced into the esophagus to perform stent fixation toward the esophageal wall. (c) The stent has been sutured to esophageal wall with OverStitch endoscopic suturing device to prevent stent migration
Repair of dilated gastrojejunal anastomosis postprevious gastric bypass (Fig. 6.3) and primary bariatric procedures for treatment of obesity

Fig. 6.3

Endoscopic correction of dilated gastrojejunal anastomosis. (a) Dilated gastrojejunal anastomosis postprevious gastric bypass. (b) Dilated anastomosis has been narrowed with separate stitches to 1 cm in diameter using OverStitch endoscopic suturing device
Facilitation of endoscopic submucosal dissection with a suture-pulley technique [26, 27]
Repair of inadvertent iatrogenic GI tract perforations [28–32]
Closure of large mucosal defect (Figs. 6.4 and 6.5) postendoscopic mucosal resection or endoscopic submucosal dissection (ESD) [33]

Fig. 6.4

Endoscopic suturing closure of mucosal defect postgastric ESD. (a) Large mucosal defect post-ESD in the antrum of the stomach. (b) Endoscopic suture has been advanced through both edges of mucosal incision at the right corner of mucosal defect post-ESD. (c) Mucosal defect post-ESD has been closed with continuous suturing line using OverStitch endoscopic suturing system

Fig. 6.5

Endoscopic suturing closure of mucosal defect postcolonic ESD. (a) ESD of a large and flat ascending colon polyp has been started with a dual knife. (b) Large mucosal defect postcompletion of ESD in ascending colon. (c) OverStitch endoscopic suturing device has been advanced into ascending colon for suturing closure of the mucosal defect post-ESD. (d) Mucosal defect has been completely closed with continuous suturing line using OverStitch endoscopic suturing system
Closure of GI tract wall defects postfull-thickness resection of GI tract lesions (Fig. 6.6) [34–38]

Fig. 6.6

Closure of GI tract wall defect postfull-thickness resection of gastric stromal tumor

In conclusion, several types of endoscopic devices have been developed for endoscopic suturing inside the GI tract. OverStitch is the most widely used endoscopic suturing device allowing the creation of endoscopic sutures, closely resembling surgical suturing. The indications for endoscopic suturing continue to expand positioning the OverStitch as a very valuable tool for therapeutic endoscopy.

References

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Chen YK. Endoscopic suturing devices for treatment of GERD: too little, too late? Gastrointest Endosc. 2005;62:44–7.CrossRefPubMed

Yew KC, Chuah SK. Antireflux endoluminal therapies: past and present. Gastroenterol Res Pract. 2013:481417.

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