Feasibility of Zeosuture M for gastric endoscopic submucosal dissection defect closure during anticoagulation: a preclinical porcine study from Japan

BACKGROUND: Endoscopic submucosal dissection (ESD) in patients undergoing anticoagulant therapy carries a risk of delayed bleeding. Zeosuture M is a novel endoscopic suturing system designed for secure mucosal closure. This study evaluated the feasibility of Zeosuture M and the short-term clinical course after mucosal closure in a warfarinized porcine ESD model. METHODS: Gastric ESD was performed in four pigs under warfarin anticoagulation (three defects per animal; 12 sites). Warfarin administration began 15 days before ESD. All defects were closed using Zeosuture M. Follow-up endoscopy was performed on postoperative days (POD) 1, 2, 4, and 8. Necropsy was conducted on POD 8. RESULTS: Technical success was 100% (12/12). The mean specimen size was 27.5±3.4 mm, mean number of stitches 3.6±0.7, closure time 28.1±8.0 minutes, and time per stitch 8.0 minutes. No uncontrolled intraprocedural bleeding, delayed hemorrhage, perforation, or peritonitis occurred. Partial loss of apposition was observed on POD 4, and all sites reopened by POD 8 without adverse clinical events. CONCLUSIONS: Zeosuture M provided early stabilization of ESD ulcers during continuous anticoagulation, enabling safe traversal of the high-risk period for delayed bleeding. This represents one of the first preclinical warfarinized porcine evaluations and suggests potential applicability in high-risk patients.