Endoscopic outcomes using a novel through-the-scope tack and suture system for gastrointestinal defect closure: a systematic review and meta-analysis

Authors

Andrew Canakis, Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, United States.
Smit S. Deliwala, Division of Gastroenterology and Hepatology, Emory University School of Medicine, Atlanta, United States.
Michael Frohlinger, Department of Medicine, University of Maryland School of Medicine, Baltimore, United States.
Benjamin Twery, Department of Medicine, University of Maryland School of Medicine, Baltimore, United States.
Justin P. Canakis, Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington, United States.
Mohammed Rifat Shaik, Department of Medicine, University of Maryland School of Medicine, Baltimore, United States.
Erik Gunnarsson, Department of Medicine, University of Maryland School of Medicine, Baltimore, United States.
Osman Ali, Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, United States.
Dushyant Singh Dahiya, Division of Gastroenterology, Hepatology and Motility, The University of Kansas School of Medicine, Kansas City, United States.
Emily Gorman, Health Sciences and Human Services Library, University of Maryland School of Medicine, Baltimore, United States.
Shayan S. Irani, Division of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, United States.
Todd H. Baron, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, United States.

Document Type

Journal Article

Publication Date

3-22-2024

Journal

Endoscopy

DOI

10.1055/a-2284-7334

Abstract

BACKGROUND: Closure of gastrointestinal defects can reduce postprocedural adverse events. Over-the-scope clips and an over-the-scope suturing system are widely available, yet their use may be limited by defect size, location, operator skill level, and need to reinsert the endoscope with the device attached. The introduction of a through-the-scope helix tack suture system (TTSS) allows for closure of large irregular defects using a gastroscope or colonoscope, without the need for endoscope withdrawal. Since its approval 3 years ago, only a handful of studies have explored outcomes using this novel device. METHODS: Multiple databases were searched for studies looking at TTSS closure from inception until August 2023. The primary outcomes were the success of TTSS alone and TTSS with clips for complete defect closure. Secondary outcomes included complete closure based on procedure type (endoscopic mucosal resection [EMR], endoscopic submucosal dissection [ESD]) and adverse events. RESULTS: Eight studies met the inclusion criteria (449 patients, mean defect size 34.3 mm). Complete defect closure rates for TTSS alone and TTSS with adjunctive clips were 77.2% (95%CI 66.4-85.3; I2=79%) and 95.2% (95%CI 90.3-97.7; I2=42.5%), respectively. Complete defect closure rates for EMR and ESD were 99.2% (95%CI 94.3-99.9; I2 = 0%) and 92.1% (95%CI 85-96; I2=0%), respectively. The adverse event rate was 5.4% (95%CI 2.7-10.3; I2=55%). CONCLUSION: TTSS is a novel device for closure of postprocedural defects, with relatively high technical and clinical success rates. Comparative studies of closure devices are needed.

APA Citation

Canakis, Andrew; Deliwala, Smit S.; Frohlinger, Michael; Twery, Benjamin; Canakis, Justin P.; Shaik, Mohammed Rifat; Gunnarsson, Erik; Ali, Osman; Dahiya, Dushyant Singh; Gorman, Emily; Irani, Shayan S.; and Baron, Todd H., "Endoscopic outcomes using a novel through-the-scope tack and suture system for gastrointestinal defect closure: a systematic review and meta-analysis" (2024). GW Authored Works. Paper 4491.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/4491

Department

School of Medicine and Health Sciences Resident Works