CLINICAL APPLICATIONS OF THE NEW ENDOSCOPIC SUTURING DEVICE

Sergey V. Kantsevoy, MD, PhD, Director of Therapeutic Endoscopy
Institute for Digestive Health and Liver Disease At Mercy Medical Center
Baltimore, Maryland, USA

Brief overview of the previously available endoscopic suturing devices

Suction based

– EndoCinch, Sew-Rite, Spiderman

Working overtubes delivering a preloaded stitch

– NDO, ARD, Esophyx

Devices based on a T-bar deployment

– TAS (Ethicon), Cook device, Olympus device

Flexible stapler (PowerMedical)
Over-the-scope clips (Ovesco, Aponas)
Devices using a curved needle

– Endovia, G-Prox, Eagle Claw, Overstitch

Overstitch endoscopic suturing device (Apollo EndoSurgery Inc, Austin, Texas, USA)

Frontloaded to a double channel upper endoscope (Olympus GiF 2T160 or 2T180)
Utilizes curved needle
Closely resembles surgical suturing
Needles with sutures can be reloaded unlimited number of times intracorporeally
Separate stitches
Continuous suture line
Intracorporeal suture finishing (cinching)

Potential clinical applications of the Overstitch suturing device:

Closure of gastric fistulas
Closure of colonic fistulas
Reduction of dilated gastro-jejunal anastomosis in patients with weight regain after bariatric surgery
Closure of iatrogenic perforations
Full-thickness resection of gastric and colonic lesions
Fixation of enteral stents

Conclusion:

We finally have a reliable, easy to use endoscopic suturing device
Overstitch has multiple advantages comparing to previously available devices:

– Use of curved needle
– Ability to re-load needle with suture without removing device from the patient
– Intra-corporeal knots (cinching)
– Ability to perform interrupted or continuous sutures

Overstitch will be used for multiple clinical applications, not limited to NOTES procedures