Prospective study on the efficacy of endoscopic through-the-scope tack and suture system for gastric peroral endoscopic myotomy mucosal incision site closure

Background and study aims Mucosal closure after gastric per-oral endoscopic myotomy (G-POEM) can be difficult due to the thick gastric mucosa. We evaluated the use of a novel through-the-scope (TTS) suture system for G-POEM mucosotomy closure. Patients and methods This was a single-center prospective study on consecutive patients who underwent G-POEM with TTS suture closure between February 2022 and August 2022. Technical success was defined as complete mucosotomy closure with TTS suture alone. On subgroup analysis, we compared performance on TTS suturing between the advanced endoscopist and the advanced endoscopy fellow (AEF) under supervision. Results Thirty-six consecutive patients (median age 60 years, interquartile range [IQR] 48.5-67], 72 % women) underwent G-POEM with TTS suture of the mucosotomy. Median mucosal incision length was 2 cm (IQR: 2-2.5). Mean mucosal closure and total procedure time were 17.5 ± 10.8 and 48.4 ± 16.8 minutes, respectively. Technical success was achieved in 24 patients (66.7 %) and 100 % of the cases were adequately closed with a combination of TTS suture and clips. When compared to the advanced endoscopist, the AEF required > 1 TTS suture system for complete closure significantly more frequently (66.7 % vs. 8.3 %, P = 0.009) and more time for mucosal closure (20.4 ± 12.1 vs. 11.9 ± 4.9 minutes, P = 0.03). Conclusions TTS suturing is effective and safe for G-POEM mucosal incision closure. With experience, technical success is high, and most closures may be achieved using a single TTS suture system alone, which has important cost and time implications. Additional comparative trials with other closure devices are need1ed.