Vivek Kumbhari, MD from the Department of Medicine and Division of Gastroenterology and Hepatology at The Johns Hopkins Medical Institutions in Baltimore, Maryland, USA presents this case from VideoGIE, “Common indications for transoral flexible endoscopic suturing.”
This video introduces the OverStitch flexible endoscopic suturing system (Apollo Endosurgery, Austin, Tx, USA). We demonstrate the use of the device during 3 commonly performed procedures. The first case demonstrates securing a fully covered esophageal stent. The second case illustrates a technique used for transoral gastric outlet reduction with simple interrupted sutures in a patient with weight regain after Roux-en-Y gastric bypass. The final case displays the closure of a posterior esophageal mucosal incision created during per oral endoscopic myotomy.
The Overstitch device is arguably the first endoscopic suturing system to be ready for “prime time” use. We felt it important to demonstrate the simplistic nature of the device to counter rumors that it is technically very demanding to use.
We believe that for those who are inexperienced with endoscopic suturing, the initial procedure to build confidence with is when securing fully covered esophageal stents. Another important point is that suturing with the endoscope in the retroflexed position is possible, although transferring the suture can be a little cumbersome.
Placement of an overtube prior to inserting the endoscope loaded with the suturing system is recommended by the manufacturer. However, we routinely insert the endoscope without an overtube and have not encountered problems intubating the esophagus.
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