Comparative Evaluation of Endoscopic Closure Techniques for Mucosal and Full-Thickness Defects: An ex vivo Study

INTRODUCTION: Reliable closure of mucosal/full-thickness defects after endoscopic treatment is crucial to prevent complications. Although various techniques have been clinically introduced, a direct comparison of these techniques has not been conducted. Thus, the present ex vivo study aimed to evaluate the closure strength of these methods. METHODS: Using a porcine stomach, 4 × 2.5-cm mucosal and full-thickness defects were prepared. Each closure was performed for three specimens. For the mucosal defects, the following methods were performed in the mucosal (group M) and muscular-mediated mucosal (group MM) closures: simple clipping (clip-M), loop-assisted closure (loop-M), line-assisted closure (line-M), and endoscopic hand suturing (EHS-M); clip-MM, line-MM, and EHS-MM. For the full-thickness defects, a single-layered closure (group F) was performed by loop-assisted closure (loop-F), line-assisted clip closure (line-F), and EHS (EHS-F). The maximum tension (N) was measured using a mechanical traction device by mechanically pulling both ends of the specimen. RESULTS: In the closure of mucosal defects, among the techniques in group M, EHS-M (11.32 ± 2.1 N) demonstrated the highest strength as compared to the other three methods. For group MM, EHS-MM (13.1 ± 5.3 N) showed the highest strength, significantly outperforming clip-MM (p = 0.03). Among the full-thickness defect closure methods, EHS-F (9.5 ± 0.73 N) had the significantly highest strength among the three methods. CONCLUSIONS: Our ex vivo data showed that EHS has superior closure strength in both mucosal and full-thickness defects. Surgery-oriented endoscopic closure appears to be a reliable method for artificially created intraluminal defects.