Endoscopic Hand Suturing After Gastric Endoscopic Submucosal Dissection in Patients with Low to Intermediate Risk of Delayed Bleeding: A Retrospective Pilot Study.

Orzeszko Z, Kasprzyk P, Zawada U, Maryńczak K, Szura M, Spychalski M.

Observational StudyOpen access

AI summary — for doctors, generated from the abstract only

In a pilot study, prophylactic endoscopic hand suturing after gastric endoscopic submucosal dissection in low-to-intermediate bleeding risk patients was feasible and trended toward lower delayed bleeding and shorter hospital stay, but required more procedure time, leaving its true clinical benefit in this lower-risk group uncertain.

What was studied

A retrospective pilot study of 46 consecutive patients with low-to-intermediate delayed bleeding risk (BEST-J score 0-2) undergoing uneventful gastric endoscopic submucosal dissection (ESD) at a Western center (September 2023-December 2024), comparing outcomes between those who received prophylactic endoscopic hand suturing (EHS) to close the mucosal defect (group A, n=20) versus those left open (group B, n=26).

Key findings

En bloc resection and complete closure were successful in 100% of attempted cases; delayed bleeding occurred in 0.0% (0/20) of the EHS group versus 7.7% (2/26) of the open group (mean difference 7.7%, 95% CI -3.3 to 18.7, not statistically significant given the wide confidence interval).
Overall procedure time was significantly longer in the EHS group (59 vs 35 minutes, mean difference 23 minutes, 95% CI 12-34); no delayed perforations occurred in either group.
Hospital stay was shorter in the EHS group (2.1 vs 2.9 days, mean difference 0.8 days, 95% CI 0.2-1.4).

Clinical relevance

The findings suggest that prophylactic endoscopic hand suturing after gastric ESD is technically feasible in a Western setting and may be associated with fewer delayed bleeding events and shorter hospital stays, but given the added procedure time and cost, and the fact that the bleeding reduction did not reach statistical significance in this small pilot, its true clinical benefit for patients at only low-to-intermediate bleeding risk remains uncertain and requires larger comparative studies.

Who should care

Medical GastroenterologySurgical Gastroenterology

Limitations

This was a small, retrospective pilot study (46 patients total) with a confidence interval for the primary bleeding outcome that crossed the null, meaning the apparent benefit was not statistically confirmed; the authors explicitly state the clinical benefit in this risk group remains uncertain.

Prophylactic hand suturing after gastric ESD was feasible and showed trends toward less bleeding and shorter hospital stay in low-to-intermediate risk patients, but added procedure time and its true clinical benefit remain uncertain pending larger studies.

This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.

Abstract

Purpose

Endoscopic hand suturing (EHS) enables closure of large mucosal defects after gastric endoscopic submucosal dissection (ESD), but evidence on its prophylactic use in patients at low to intermediate risk of delayed bleeding (DB) is limited. This pilot study evaluated the feasibility of EHS following gastric ESD in a Wester setting.

Methods

This retrospective pilot study included 46 consecutive patients with low to intermediate DB risk (BEST-J score 0-2) who underwent uneventful gastric ESD between September 2023 and December 2024. Post-ESD defects were closed using EHS (group A, n = 20) or left open (group B, n = 26). Primary outcomes were technical success of closure and DB rate. Secondary outcomes included overall procedure time (OPT), perforation rate, and length of hospital stay (HS).

Results

En bloc resection and complete closure were successful in 100% of attempted cases. DB in group A was 0.0% (0/20) versus 7.7% (2/26) in group B (mean difference [MD] 7.7%; 95%CI: - 3.3 to 18.7). OPT was longer in the EHS group (59 ± 19 vs. 35 ± 17 min; MD 23 min; 95%CI: 12-34). No delayed perforations occurred. HS was shorter in group A (2.1 ± 1.0 vs. 2.9 ± 1.1 days; MD 0.8 days; 95%CI: 0.2-1.4).

Conclusion

In a Western setting, EHS after gastric ESD is feasible and enables reliable defect closure. However, implementation of EHS is associated with increased procedure time and cost, and its clinical benefit in low- to intermediate-risk patients remains uncertain.

Clinicaltrials

gov Identifier: NCT06779266 retrospectively registered.

DOI

10.1007/s10620-026-10168-5

PMID

42584762

PMCID

PMC13585951

Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.

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