A novel flexible endoscopic C-shaped suturing device for gastrointestinal wound closure: First survival study in pigs (with video)

Background and study aims Flexible endoscopic suturing for gastrointestinal wounds is technically challenging and has limited clinical adoption. We developed a flexible endoscopic C-shaped suturing device (E-CSD) and conducted a preliminary pilot study to assess its feasibility and safety. Methods The novel E-CSD was used to close wounds in live pigs following endoscopic full-thickness resection and endoscopic submucosal dissection. Primary outcomes included wound size and location, procedure time, technical success rate, intraoperative and postoperative complications (e.g., device-related mucosal damage, bleeding, and perforation), and wound healing status, including suture maintenance, during a 30-day follow-up period with weekly endoscopy. Results Four wounds were established in two pigs, including two perforated wounds (one each in the stomach and rectum) and two non-perforated wounds (one each in the stomach and colon). The wound sizes ranged from 1.5 x 3.5 to 4.0 x 5.0cm. Complete closure was achieved in all cases (4/4, 100%), with a mean suturing time of 11 minutes (range 8–16). No significant complications were reported during the 30-day follow-up period. One case showed minor dehiscence on postoperative day 7, whereas the other wounds remained technically closed and healed progressively into scars. Conclusions The newly developed E-CSD successfully closed both perforated and non-perforated gastrointestinal wounds in live pigs with no significant complications during the 30-day follow-up period. As the first animal study using this method, the findings provide preliminary evidence of the feasibility and safety of E-CSD for gastrointestinal wound closure.