ENDOSCOPIC HAND-SUTURING

Abstract

Clip suturing was previously the main preventive measure used for management of delayed perforation or posterior hemorrhage associated with endoscopic treatment. A recent study by Goto et al. describes endoscopic hand-suturing (EHS) using an endoscopic flexible needle holder and sutures as a novel suture method to close large mucosal defects observed after ESD. EHS can be performed endoscopically alone, with sutures similar to surgery. Using a novel endoscopic flexible needle holder, the surgical suture is advanced to the target site, and a curved needle is used to firmly grasp and pass the suture through all layers of the gastrointestinal tract wall with placement of continuous sutures. Therefore, EHS ensures more reliable sutures compared with conventional clip suturing and can prevent delayed complications. Although EHS was originally introduced for gastric lesions, this strategy may also be useful for colorectal lesions. In this article, we discuss the role of EHS for management of the post-colorectal ESD ulcer.