ENDOSCOPIC SUTURING: THE NEW FRONTIER OF THERAPEUTIC ENDOSCOPY

Abstract

Suturing is a basic and essential skill required in any type of surgery; however, in the field of flexible endoscopic surgery (FES), endoscopic suturing devices have not become available to date in Japan due to several technical difficulties in incorporating the suturing technology in flexible endoscopes. OverStitch and Incisionless Operating Platform are the two main endoscopic suturing devices that are currently commercially available in the United States (US). These devices have made complex surgical procedures amenable to endoscopic treatments, including endoscopic closure of large iatrogenic gastrointestinal (GI) perforations, endoscopic full-thickness resection, endoscopic closure of chronic GI fistula, esophageal stent fixation, and endoscopic treatment for bariatric patients. These suturing skills in endoscopic procedures are currently recognized as crucial, especially for advanced endoscopists in the US to be able to perform these procedures safely and effectively. In Japan, we have been seeing the limitations of endoscopic defect closure using the existing traditional endoscopic devices. Early approval by the Japanese government of those devices with known scientifically-proven efficacy is required to further expand the field of FES and ensure patientsʼ safety in Japan.