TY - JOUR
T1 - Common and Uncommon Problems During Endoscopic Suturing With Apollo Overstitch
T2 - Tips and Tricks for Troubleshooting
AU - Bove, Vincenzo
AU - Gallo, Camilla
AU - Pontecorvi, Valerio
AU - Schepis, Tommaso
AU - Costamagna, Guido
AU - Boškoski, Ivo
N1 - Funding Information:
Conflicts of Interest Professor Guido Costamagna is consultant for Cook Medical, Boston Scientific, and Olympus and had General payments/Minor Food and Beverage from Cook Medical, Boston Scientific, and Olympus. Dr Ivo Bo?koski is consultant for Apollo Endosurgery, Cook Medical, Boston Scientific, and Endo Tools, is Apollo Endosurgery Research Grant Holder, is Endo Tools scientific board member, and had General payments/Minor Food and Beverage from Apollo Endosurgery, Cook Medical, Boston Scientific, and Endo Tools. All the other authors have nothing to disclose.
Publisher Copyright:
© 2021 Elsevier Inc.
PY - 2021/1
Y1 - 2021/1
N2 - Background and Aims: The Apollo Endosurgery OverStitch is currently the most used endoscopic suturing device. Suturing techniques are still not fully standardized and their training does not often provide sufficient competence. Thus, several technical problems may occur, also due to engineering complexity of the suturing device. The experience of a high-volume Center is reported as to suggest tips and tricks for troubleshooting. Methods: A retrospective analysis was conducted on a prospectively collected database reporting patients treated with Apollo Endosurgery OverStitch between November 2014 and October 2020: Endoscopic Sleeve Gastroplasty (ESG), Transoral Outlet Reduction (TORe) of gastric by-pass, suturing of gastrointestinal fistulas or perforations and esophageal stents fixation were performed. Technical difficulties encountered were reviewed and their respective solutions were documented. Results: Out of a total of 393 suturing procedures, 252 ESG, 102 TORe, 23 suturing of fistulas or perforations, and 16 fixations of esophageal stents were realized. Breakage of the Suture Loading Tab occurred in 13% of the cases and misalignment between the needle driver and the anchor exchange was reported in 8.4% of the procedures. It happened respectively in 6.4% and in 0.2% of the cases that the thread made a loop behind the needle driver and that the needle driver blocked in the closed position. Tricks on how to manage these problematic situations and tips on how to simplify the suturing procedure are reported. Conclusions: During endoscopic suturing many issues can arise. Troubleshooting tricks and simplifying tips may help endoscopists in accelerating their learning curves and, thus, contribute to better outcomes of the procedures.
AB - Background and Aims: The Apollo Endosurgery OverStitch is currently the most used endoscopic suturing device. Suturing techniques are still not fully standardized and their training does not often provide sufficient competence. Thus, several technical problems may occur, also due to engineering complexity of the suturing device. The experience of a high-volume Center is reported as to suggest tips and tricks for troubleshooting. Methods: A retrospective analysis was conducted on a prospectively collected database reporting patients treated with Apollo Endosurgery OverStitch between November 2014 and October 2020: Endoscopic Sleeve Gastroplasty (ESG), Transoral Outlet Reduction (TORe) of gastric by-pass, suturing of gastrointestinal fistulas or perforations and esophageal stents fixation were performed. Technical difficulties encountered were reviewed and their respective solutions were documented. Results: Out of a total of 393 suturing procedures, 252 ESG, 102 TORe, 23 suturing of fistulas or perforations, and 16 fixations of esophageal stents were realized. Breakage of the Suture Loading Tab occurred in 13% of the cases and misalignment between the needle driver and the anchor exchange was reported in 8.4% of the procedures. It happened respectively in 6.4% and in 0.2% of the cases that the thread made a loop behind the needle driver and that the needle driver blocked in the closed position. Tricks on how to manage these problematic situations and tips on how to simplify the suturing procedure are reported. Conclusions: During endoscopic suturing many issues can arise. Troubleshooting tricks and simplifying tips may help endoscopists in accelerating their learning curves and, thus, contribute to better outcomes of the procedures.
KW - Bariatric endoscopy
KW - Endoscopic sleeve gastroplasty
KW - Endoscopic suturing
KW - Transoral outlet reduction of gastric by-pass
KW - Troubleshooting
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U2 - 10.1016/j.tige.2021.03.001
DO - 10.1016/j.tige.2021.03.001
M3 - Article
AN - SCOPUS:85108523584
SN - 2666-5107
VL - 23
SP - 220
EP - 225
JO - Techniques and Innovations in Gastrointestinal Endoscopy
JF - Techniques and Innovations in Gastrointestinal Endoscopy
IS - 3
ER -