[Endoscopic hand-suturing combined with titanium clips for rectal defects closure after endoscopic submucosal dissection: a pilot study]

Objective: To explore the feasibility of endoscopic hand-suturing (EHS) for rectal defects closure after endoscopic submucosal dissection (ESD), and the clinical practicability of EHS combined with titanium clips. Methods: This is a prospective study performed by two experienced endoscopists from the Cancer Hospital, Chinese Academy of Medical Sciences who had received EHS training in sixporcine gastric ESD defects in vivo before the study. From December 2022 to February 2022, 20 patients with rectal mucosal lesions or submucosal diseases underwent ESD. Then EHS combined with titanium clips was adopted to close the rectal ESD defects. Specifically, we first sutured the defects as much as possible through EHS, then use titanium clips to fix the tail of the suture, and finally use additional titanium clips to close the residual parts of the defects that cannot be sutured. The main observational indicators were complete closure of the wound and delayed bleeding within one month after surgery. Results: In the 20 rectal cases, the size of defects ranged from 2.2 to 3.6 cm, with a median of 2.7 cm. All cases achieved complete closure without delayed bleeding, of which 12 (60.0%) were completely sutured with EHS and 8 (40.0%) required additional titanium clips to achieve complete closure after suturing. Conclusion: EHS technique is feasible and safe for rectum. EHS combined with titanium clips can also effectively close the rectal ESD defects, prevent postoperative delayed bleeding, and may be easier to be implemented in clinical practice.

Comparison of the results of laparoscopic appendectomies with application of different techniques for closure of the appendicular stump

Background

Nowadays laparoscopy is used frequently not only in elective surgery but also in abdominal emergencies, including acute appendicitis. There are several techniques used to close the appendicular stump during laparoscopic appendectomy. The aim of the study was to present and compare the results of minimally invasive appendectomies performed with the use of endoscopic staplers (group A), titanium endoclips (group B) and invaginating sutures (group C).

Methods

Three hundred seven patients (mean age = 35.6; SD = 15.9; 178 males,129 females) operated on laparoscopically for acute appendicitis from January 2010 to December 2014 at our department were included in the study. We reviewed retrospectively patients’ data including: age, sex, duration of the surgical procedure and hospital stay, mortality, intraoperative and postoperative complication rates in all analyzed groups.

Results

There were 102 patients in group A (mean age = 35.8;SD = 15.4; 57 males, 45 females). The average hospital stay in this group was 4.3 days (SD = 1.7), average operation time was 62.0 min (SD = 15), postoperative complication rate was 5.9 %. There were 160 patients in group B (mean age = 35.0; SD = 16.3; 96 males, 64 females). The average hospital stay in this group was 3.6 days (SD = 1.4), average operation time was 62.9 min (SD = 13.5), postoperative complication rate was 5.6 %. There were 45 patients in group C (mean age =37.3; SD = 15.8; 25 males, 20 females). The average hospital stay in this group was 4.6 days (SD = 2.0), average operation time was 73.9 min (SD = 20.8), postoperative complication rate was 6.7 %. There were no intraoperative complications and no mortality in all compared groups of patients operated on laparoscopically for acute appendicitis.

Conclusions

Laparoscopic appendectomies with application of different techniques for closure of the appendicular stump are useful and safe. In our study the shortest hospital stay and lowest complication rate were observed in patients operated with the use of titanium endoclips. The longest hospital stay and operation time and the highest complication rate was associated with the use of invaginating sutures.

Clinical effects of endoscopic titanium clipping combined with proton pump inhibitor therapy in treatment of non-variceal upper gastrointestinal bleeding

AIM: To evaluate the clinical effects of endoscopic titanium clipping combined with proton pump inhibitor therapy in the treatment of non-variceal upper gastrointestinal bleeding.

METHODS: One hundred and forty-six patients with acute non-variceal upper gastrointestinal bleeding treated at our hospital from January 2012 to December 2013 were divided into a research group and a control group according to the method of treatment. The study group (73 cases) received endoscopic titanium clipping together with proton pump inhibitor therapy, and the control group (73 cases) only received proton pump inhibitor treatment. Treatment effectiveness, time to hemostasis, blood loss, total amount of blood transfusion, rebleeding rate, and incidence of adverse reactions during follow-up period were recorded and compared for the two groups.

RESULTS: The effective rate in the research group was significantly higher than that in the control group (P < 0.05). The time to hemostasis was significantly shorter and the blood loss and total amount of blood transfusion were significantly less in the research group than in the control group (P < 0.05). The rebleeding rate in the research group was significantly lower than that in the control group (P < 0.05), but no significant difference was found in the incidence of adverse reactions between the two groups (P > 0.05).

CONCLUSION: Endoscopic titanium clipping combined with proton pump inhibitor therapy has a higher effective rate than the single use of proton pump inhibitors in the treatment of non-variceal upper gastrointestinal bleeding, and the combination therapy is associated with a shorter time to hemostasis and a low incidence of rebleeding, withouth serious adverse reactions.