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LONG TRANSPARENT CAP SUTURING TECHNIQUE FOR THE CLOSURE OF ENDOSCOPIC FULL-THICKNESS RESECTION DEFECTS: A NOVEL ALTERNATIVE

Nan Dai 1, Saif Ullah 1, Xinguang Cao 1

Affiliations

1 The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China

Summary

AI Generated

A retrospective study of 62 patients evaluated a novel long transparent cap suturing technique for closing full-thickness gastric defects after endoscopic resection of submucosal tumors, achieving 100% technical success with low complication rates.

All 62 patients who underwent endoscopic full-thickness resection for gastric submucosal tumors between January 2017 and March 2023 had successful defect closure using the long transparent cap suturing technique (100% technical success rate).
Median tumor size was 1.5 cm, median suturing time was 14 minutes, and median hospital stay was 4.5 days; postoperative complications included bleeding in 1 case, fever in 3 cases, and abdominal pain in 2 cases.
During median 29-month follow-up, no residual lesions, tumor recurrence, metastasis, or digestive tract fistulas were observed.
The authors concluded that this technique offers a simple and effective alternative to existing closure methods, which may have limited availability in some centers due to equipment variations and cost considerations.

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Abstract

Introduction

Gastric submucosal tumors (SMTs) are elevated lesions originating from below the gastric mucosal layer. Pathological types of SMTs include stromal tumors, leiomyomas, lipomas, etc., with stromal tumors being the most common¹. Endoscopic full-thickness resection (EFTR) has gradually become the main treatment modality for SMTs ². However, in order to completely remove lesions involving the submucosal and deeper layers, EFTR often involves intentional perforation during the procedure. Therefore, successful closure of the full-thickness defect after the procedure is crucial to prevent serious complications such as pneumothorax and pneumoperitoneum³. Currently, availabloe techniques for the full-thickness GI wall defects closure includes metal clip closure, nylon suture purse-string closure, Over-The-Scope-Clip system (OTSC), and the OverStitch suture system ^4-5. However, due to variations in endoscopic center equipment, individual physician skills, and patient economic conditions, most of the suture devices are not widely available including in China. Using metal clips alone may sometimes be insufficient for closing the large GI defects, while the purse-string suture technique can be relatively cumbersome.

Aims & Methods

The aim of this study was to evaluate the safety and efficacy of the long transparent cap suturing technique for the closure of large endoscopic full-thickness resection (EFTR) defects. A total of 62 patients who underwent EFTR for their large gastric submucosal tumors at the First Affiliated Hospital of Zhengzhou University between January 2017 and March 2023 were included in this study. The novel long transparent cap suturing technique was used for EFTR defect closure in all the patients.

Results

The procedure technical success rate was 100%. The median tumor size was 1.5 cm (range: 0.6-6.5 cm), and the median number of metal clips used was 7 (range: 4-14). The median EFTR procedure time was 53.5 minutes (range: 22-136 minutes), and the median suturing time was 14 minutes (range: 3-45 minutes). The median length of postoperative hospital stay was 4.5 days (range: 3-7 days). Postoperative complications including bleeding occured in 1 case, fever in 3 cases, and abdominal pain in 2 cases. During the median 29 months (range: 7-79 months) of follow up, no residual lesions, tumor recurrence, or metastasis were detected, and no formation of digestive tract fistulas or sinuses was observed.

Conclusion

The long transparent cap suturing technique is a simple, safe, and effective method for wound closure after EFTR. It is beneficial for clinical application and widespread use.

References

1 Sharzehi K, Sethi A, Savides T. Aga clinical practice update on management of subepithelial lesions encountered during routine endoscopy: Expert review. Clin Gastroenterol Hepatol 2022; 20: 2435-43.e4.
2 Liu S, Zhou X, Yao Y, Shi K, Yu M, Ji F. Resection of the gastric submucosal tumor (g-smt) originating from the muscularis propria layer: Comparison of efficacy, patients' tolerability, and clinical outcomes between endoscopic full-thickness resection and surgical resection. Surg Endosc 2020; 34: 4053-64.
3 Zhou PH, Yao LQ, Qin XY et al. Endoscopic full-thickness resection without laparoscopic assistance for gastric submucosal tumors originated from the muscularis propria. Surg Endosc 2011; 25: 2926-31.
4 Verlaan T, Voermans RP, van Berge Henegouwen MI, Bemelman WA, Fockens P. Endoscopic closure of acute perforations of the gi tract: A systematic review of the literature. Gastrointest Endosc 2014; 82: 618-28.e5.
5 Shi D, Li R, Chen W et al. Application of novel endoloops to close the defects resulted from endoscopic full-thickness resection with single-channel gastroscope: A multicenter study. Surg Endosc 2017; 31: 837-42.

Conference

UEG Week Vienna 2024

Topics

Oesophagus

Submission format

Abstract

Session

OESOPHAGEAL, GASTRIC AND DUODENAL (Posters)

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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Video case: Failed ERCP in a Billroth II patient with altered anatomy: What to do now?

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Video case: Failed ERCP in a Billroth II patient with altered anatomy: What to do now?

Vasile Sandru 1

Affiliations

1 Bucharest Emergency Hospital, Bucharest, Romania

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Abstract

Event

Postgraduate Teaching Programme Barcelona 2026

Topics

Hepatobiliary Endoscopy

Session

Are you stuck in the biliary cannulation nightmare: Wake up, here comes the sun

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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T1b squamous cancer (Complete Session)

ALIGNING PATIENT EXPECTATIONS AND PHYSICIAN PERSPECTIVES ON NUTRITIONAL TREATMENT IN CROHN’S DISEASE: OVERCOMING CHALLENGES AND ENHANCING OPPORTUNITIES FOR EEN THERAPY

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UEG Presentation

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How to define the hot spots?

Marjolijn Duijvestein 1

Affiliations

1 Radboudumc, Nijmegen, Netherlands

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Abstract

Event

UEG Week Berlin 2025

Topics

Endoscopy Nurses

Session

Is your GI-practice sustainable?

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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T1b squamous cancer (Complete Session)

ALIGNING PATIENT EXPECTATIONS AND PHYSICIAN PERSPECTIVES ON NUTRITIONAL TREATMENT IN CROHN’S DISEASE: OVERCOMING CHALLENGES AND ENHANCING OPPORTUNITIES FOR EEN THERAPY

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NEUTROPHIL-FIBROBLAST CROSSTALK THROUGH JAK/STAT SIGNALING AND IL-8 AS A NEW MECHANISM OF CROHN’S DISEASE IMMUNOFIBROSIS

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NEUTROPHIL-FIBROBLAST CROSSTALK THROUGH JAK/STAT SIGNALING AND IL-8 AS A NEW MECHANISM OF CROHN’S DISEASE IMMUNOFIBROSIS

Efstratios Gavriilidis 1, Anastasia Maria Natsi 1, Christina Antoniadou 1, Dionysios Kogias 1, Victoria Tsironidou 1, NIKOS KAFALIS 1, Stylianos Didaskalou 2, Maria Koffa 2, Alexandra Giatromanolaki 1, Georgios Kouklakis 1, Konstantinos Ritis 1, Panagiotis Skendros 1

Affiliations

1 Democritus University of Thrace, Faculty of Medicine, Alexandroupolis, Greece

2 Democritus University of Thrace, Department of Molecular Biology and Genetics, Alexandroupolis, Greece

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Abstract

Introduction

Crohn’s disease (CD) is characterized by chronic uncontrolled inflammation which often leads to intestinal fibrosis. Up to 70% of patients with CD will develop strictures and will undergo surgery as the only available therapeutic option. However, the pathogenesis of CD fibrosis remains incompletely understood. Studies are mainly focused on mesenchymal cells, cytokines and growth factors, whereas the role of neutrophils remains elusive.^1–5 Previous data by our group indicated that neutrophils may acquire a pre-fibrotic role by inducing the differentiation and activation of fibroblasts.^6,7

Aims & Methods

This study aims to investigate for the first time the role of neutrophil-intestinal fibroblast interplay in the pathogenesis of CD immunofibrosis suggesting possible targets for therapeutic interventions.
Neutrophils and intestinal biopsies were obtained from treatment naive patients with moderate to severe CD (CDAI ≥220) and UC (Mayo DAI ≥6). Additionally, sex- and age-matched healthy individuals (HI), were served as controls. Intestinal tissues were characterized using immunohistochemistry and immunofluorescence. Primary intestinal fibroblasts (PIFbs) isolated from tissue specimens were also studied using real-time qPCR, confocal immunofluorescence imaging, in-cell ELISA (cytoblot) and collagen assay. Various inflammatory mediators were measured in cell cultures supernatants with ELISA and multiplex bead-based flow cytometry. The migratory capacity of neutrophils was assessed by a chemotaxis cell migration fluorometric assay.

Results

PIFbs from patients with CD, compared to UC and HI, exhibited a fibrotic phenotype that was characterized by low Krüppel-like Factor 2 (KLF2) and increased Cellular Communications Network Factor 2 (CCN2) mRNA and protein expression leading to excessive collagen production. Neutrophil-fibroblast co-existence was obvious in intestinal tissue fibrotic lesions of CD patients. In line with this, PIFbs culture supernatants from CD patients yielded high levels of IL-8 and increased chemotactic activity for HI neutrophils, which was reduced significantly upon IL-8 neutralization. Of note, compared to UC, neutrophil culture extracts from CD patients downregulated KLF2 and induced CCN2 expression in HI PIFbs acquiring a CD pre-fibrotic phenotype. This neutrophil-mediated immunofibrotic effect was abolished in-vitro by pharmaceutical inhibition of JAK/STAT signaling in PIFbs.

Conclusion

These results, provide a novel mechanistic basis for immunofibrosis in CD suggesting neutrophil/JAK/STAT/fibroblast/IL-8 molecular pathway as a candidate therapeutic target.

References

1. Zidar N, Langner C, Jerala M, Boštjančič E, Drobne D, Tomažič A. Pathology of Fibrosis in Crohn’s Disease—Contribution to Understanding Its Pathogenesis. Front Med (Lausanne). 2020;7:167. doi:10.3389/fmed.2020.00167
2. Santacroce G, Lenti MV, Di Sabatino A. Therapeutic Targeting of Intestinal Fibrosis in Crohn’s Disease. Cells. 2022;11(3):429. doi:10.3390/cells11030429
3. Wéra O, Lancellotti P, Oury C. The Dual Role of Neutrophils in Inflammatory Bowel Diseases. J Clin Med. 2016;5(12):118. doi:10.3390/jcm5120118
4. Lipson KE, Wong C, Teng Y, Spong S. CTGF is a central mediator of tissue remodeling and fibrosis and its inhibition can reverse the process of fibrosis. Fibrogenesis Tissue Repair. 2012;5(Suppl 1):S24. doi:10.1186/1755-1536-5-S1-S24
5. Salas A, Hernandez-Rocha C, Duijvestein M, et al. JAK-STAT pathway targeting for the treatment of inflammatory bowel disease. Nat Rev Gastroenterol Hepatol. 2020;17(6):323-337. doi:10.1038/s41575-020-0273-0
6. Chrysanthopoulou A, Mitroulis I, Apostolidou E, et al. Neutrophil extracellular traps promote differentiation and function of fibroblasts. The Journal of Pathology. 2014;233(3):294-307. doi:10.1002/path.4359
7. Chrysanthopoulou A, Antoniadou C, Natsi AM, et al. Down-regulation of KLF2 in lung fibroblasts is linked with COVID-19 immunofibrosis and restored by combined inhibition of NETs, JAK-1/2 and IL-6 signaling. Clin Immunol. 2023;247:109240. doi:10.1016/j.clim.2023.109240

Disclosure

This study was supported by the Greek General Secretariat for Research and Technology (GSRT), Research & Innovation Programme CytoNET, grant MIS-5048548 and by GSRT, Regional Excellence Programme InTechThrace, grant MIS-5047285.

Event

UEG Week Copenhagen 2023

Topics

IBD

Submission format

Abstract

Session

IBD: From principles to therapy

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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UEG Presentation

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T1b squamous cancer (Complete Session)

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Abstract

Event

UEG Week Vienna 2024

Topics

Digestive Oncology Oesophagus

Session

T1b squamous cancer

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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T1b squamous cancer (Complete Session)

ALIGNING PATIENT EXPECTATIONS AND PHYSICIAN PERSPECTIVES ON NUTRITIONAL TREATMENT IN CROHN’S DISEASE: OVERCOMING CHALLENGES AND ENHANCING OPPORTUNITIES FOR EEN THERAPY

Haggai Bar-Yoseph

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Fons van der Sommen

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ALIGNING PATIENT EXPECTATIONS AND PHYSICIAN PERSPECTIVES ON NUTRITIONAL TREATMENT IN CROHN’S DISEASE: OVERCOMING CHALLENGES AND ENHANCING OPPORTUNITIES FOR EEN THERAPY

Ramit Magen-Rimon 1, David Mamet 2, Meis Assaf 1,2, Zohar Tal-Lashinsky 1,2, Oxana Libman 1, Mattitiahu Waterman 2,1, Haggai Bar-Yoseph 1,2

Affiliations

1 Rambam Health Care Campus, Haifa, Israel

2 Technion-Israel Institute of Technology, Haifa, Israel

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Abstract

Introduction

Exclusive enteral nutrition (EEN) is effective and commonly used to induce remission in pediatric Crohn’s disease (CD). Nevertheless, the reasons for its low usage in adult patients are not fully understood. We aimed to identify the barriers to EEN use, evaluate the approaches of patients and physicians, and compare them.

Aims & Methods

An online questionnaire was sent to adult CD patients and gastroenterologists. The questionnaires included demographics, disease characteristics, education, previous EEN exposure, approach to EEN and approach to potential barriers (Likert scale of 1-5). Descriptive analysis was followed by comparative analysis of patients/physicians reluctant to use/provide EEN and those who were not reluctant. Logistic regression was applied to search for variables and potential barriers associated with EEN-reluctance. An association network was generated to visualize how different barriers contribute to reluctance to trying EEN.

Results

Three-hundred and fifteen CD patients and 42 physicians completed the questionnaire. The mean age was 36.7 (SD±16) with a median disease duration of 10 (range 0-60) years. Previous EEN use was reported by 40% (n=101), while EEN-reluctance was reported by 20.3% (n=64). No significant baseline variables were found to be associated with EEN reluctance in univariate and multivariate analyses, except for current advanced treatment (biologic/small molecules) use (OR 2.06 [95%CI 1.05-4.35]). Among physicians, 71% had previously prescribed EEN to a patient, while 81% were willing to prescribe EEN. Knowledge of remission rates in adult patients using EEN varied widely. The indication for EEN use varied from mild-moderate disease (41% of respondents) to complicated disease (38% for penetrating disease, 55.9% for severe disease, 52.9% for structuring and 55.9% for malnourished patients). Previous EEN prescription was associated with willingness for future EEN recommendation (OR 4.66 [95%CI 1.11-19.54]). Top-ranked barriers perceived by patients were lack of food variety (65% with scored 4-5), lack of meal-associated social interaction (59% with scored 4-5) and treatment duration (49% scored 4-5). The respondents were less concerned about potential complications (14.6% scored 4-5), treatment-related diarrhea/pain (25.1% scored 4-5) and the notion that the formula is dairy-sourced (29.2% scored 4-5). For physicians, lack of food-associated social interaction (67.3% scored 4-5) and concern about taste (54.7% scored 4-5) were ranked highest among the perceived patient barriers.
Overall, the physicians’ perspectives largely aligned with those of the patients. However, we found that ‘lack of food variety’ and ‘hunger concerns’ were barriers scored significantly higher by patients than physicians (p<0.05 for both). Network analysis revealed the top three patient barriers associated with EEN reluctance were ‘food variety’, ‘treatment duration’ and ‘fear of liquid only diet’, which were correlated with each other. Supportive factors that could facilitate EEN use were: direct communication with a staff member (68.6% scored 4-5) full funding of the formula (65% scored 4-5), family support (59.7% scored 4-5) and talking with other patients that are EEN experienced (52% scored 4-5). Overall, 47% of the respondents expressed a desire to hear more about EEN, and 87.6% preferred to receive information about EEN from their physician.

Conclusion

Most patients with CD are open to discussing EEN and wish to discuss it with their physicians. Potential barriers to address are the tactile and social eating experience as well as the length of therapy.

Conference

UEG Week Berlin 2025

Topics

Small Intestine & Nutrition

Submission format

Abstract

Session

NUTRITION (Posters)

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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How to create AI for Barrett's oesophagus and how to integrate it in its management

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UEG Presentation

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

How to create AI for Barrett's oesophagus and how to integrate it in its management

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How to create AI for Barrett's oesophagus and how to integrate it in its management

Jacques J. Bergman 1, Fons van der Sommen 2

Affiliations

1 Academic Medical Centre - Gastroenterology & Hepatology, Academic Medical Centre; Amsterdam/NL, Amsterdam, Netherlands

2 Eindhoven University of Technology, Eindhoven, Netherlands

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Abstract

Event

UEG Week Copenhagen 2023

Topics

Education & Training Endoscopy Histopathology

Session

Disease primer: AI - the new standard in endoscopy and pathology

Published

2023

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