VIDEO: Endoscopic Suturing for Ulcer Exclusion

Researchers report the use of endoscopic surgical suturing for ulcer exclusion in the July issue of Gastroenterology, and provide a video of their procedure.

It is important to prevent rebleeding of peptic ulcers. A prototype endoscopic suturing device has been developed to provide hemostasis in patients with massively bleeding gastric ulcers.

Philip Wai Yan Chiu et al describe using the device to treat a 78-year-old man, performing surgical ulcer exclusion and endoscopic suturing for large bleeding gastric ulcer.

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In describing the procedure, they say that the overstitch device was introduced through an overtube. The first suture plication was performed over the superior edge of the ulcer. After exchange of the anchor, the second suture plication was performed over the inferior ulcer edge. This process was continued until a figure-8 suture was formed over the ulcer. The anchor was then dropped and the suture was tightened with the cinching device. The ulcer was excluded with adequate hemostasis.

The patient had no clinical evidence of rebleeding, and endoscopy analysis 72 hrs later confirmed secure closure of the ulcer.

Chiu et al state this is a better method to prevent rebleeding, compared with high-dose proton pump inhibitor infusion or prophylactic angiographic embolization.

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