title: A Large Multicenter Experience With Endoscopic Suturing for Management of Gastrointestinal Defects and Stent Anchorage in 122 Patients: A Retrospective Review.
abstract: OBJECTIVE
  To describe a multicenter experience using an endoscopic suturing device for management of gastrointestinal (GI) defects and stent anchorage.
  
  
  BACKGROUND
  Endoscopic closure of GI defects including perforations, fistulas, and anastomotic leaks as well as stent anchorage has improved with technological advances. An endoscopic suturing device (OverStitch; Apollo Endosurgery Inc.) has been used.
  
  
  METHODS
  Retrospective study of consecutive patients who underwent endoscopic suturing for management of GI defects and/or stent anchorage were enrolled between March 2012 and January 2014 at multiple academic medical centers. Data regarding demographic information and outcomes including long-term success were collected.
  
  
  RESULTS
  One hundred and twenty-two patients (mean age, 52.6 y; 64.2% females) underwent endoscopic suturing at 8 centers for stent anchorage (n=47; 38.5%), fistulas (n=40; 32.7%), leaks (n=15; 12.3%), and perforations (n=20; 16.4%). A total of 44.2% underwent prior therapy and 97.5% achieved technical success. Immediate clinical success was achieved in 79.5%. Long-term clinical success was noted in 78.8% with mean follow-up of 68 days. Clinical success was 91.4% in stent anchorage, 93% in perforations, 80% in fistulas, but only 27% in anastomotic leak closure.
  
  
  CONCLUSIONS
  Endoscopic suturing for management of GI defects and stent anchoring is safe and efficacious. Stent migration after stent anchoring was reduced compared with published data. Long-term success without further intervention was achieved in the majority of patients. The role of endoscopic suturing for repair of anastomotic leaks remains unclear given limited success in this retrospective study.
authors.affiliation: *Weill Cornell Medical College †Mount Sinai School of Medicine ‡Columbia University Medical Center ∥North Shore University Hospital Long Island Jewish, New York, NY §Jefferson Medical College, Philadelphia, PA ¶Johns Hopkins University, Baltimore, MD.
authors.forename: Reem Z
authors.initials: RZ
authors.lastname: Sharaiha
authors.forename: Nikhil A
authors.initials: NA
authors.lastname: Kumta
authors.forename: Ersilia M
authors.initials: EM
authors.lastname: DeFilippis
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Dimaio
authors.forename: Susana
authors.initials: S
authors.lastname: Gonzalez
authors.forename: Tamas
authors.initials: T
authors.lastname: Gonda
authors.forename: Jason
authors.initials: J
authors.lastname: Rogart
authors.forename: Ali
authors.initials: A
authors.lastname: Siddiqui
authors.forename: Paul S
authors.initials: PS
authors.lastname: Berg
authors.forename: Paul
authors.initials: P
authors.lastname: Samuels
authors.forename: Larry
authors.initials: L
authors.lastname: Miller
authors.forename: Mouen A
authors.initials: MA
authors.lastname: Khashab
authors.forename: Payal
authors.initials: P
authors.lastname: Saxena
authors.forename: Monica R
authors.initials: MR
authors.lastname: Gaidhane
authors.forename: Amy
authors.initials: A
authors.lastname: Tyberg
authors.forename: Julio
authors.initials: J
authors.lastname: Teixeira
authors.forename: Jessica
authors.initials: J
authors.lastname: Widmer
authors.forename: Prashant
authors.initials: P
authors.lastname: Kedia
authors.forename: David
authors.initials: D
authors.lastname: Loren
authors.forename: Michel
authors.initials: M
authors.lastname: Kahaleh
authors.forename: Amrita
authors.initials: A
authors.lastname: Sethi
mesh_terms: D000328:Adult; D000368:Aged; D057868:Anastomotic Leak / Q000601:surgery; D016154:Digestive System Fistula / Q000601:surgery*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005767:Gastrointestinal Diseases / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D013536:Suture Techniques; D013997:Time Factors; D016896:Treatment Outcome