Endoscopic Hand-Suturing: The Revolution in Advanced Endoscopy
Discover how the Sutuart system is transforming endoscopic procedures, offering durable and safe closures that expand the boundaries of minimally invasive treatment
Endoscopic hand-suturing is revolutionizing the treatment of complications and complex procedures
Quick Summary - The Essentials
🎯 What is endoscopic suturing?
- • Technique that allows "sewing" inside the digestive tract without surgery
- • Uses absorbable threads that dissolve on their own over time
- • Leaves no external scars and requires no incisions
- • Performed through endoscopy, like a regular gastroscopy
✨ Main benefits:
- • 95%+ success rate in defect closure
- • Reduces bleeding and post-procedure complications
- • Allows treatment of perforations and fistulas without surgery
- • Expands the possibilities of endoscopic treatments
What is endoscopic hand-suturing?
Imagine if we could "sew" wounds or defects inside your stomach or intestine without needing to open you up with surgery. That's exactly what endoscopic hand-suturing allows, a revolutionary technique that is completely changing how we treat complex digestive problems.
Traditionally, when we performed advanced endoscopic procedures like removing large lesions, a "wound" remained on the stomach or intestinal wall. Previously, we had to rely on the body to close it on its own, or use metal clips (like small staples) that didn't always work well. Now, with the Sutuart system from Olympus, we can literally sew those wounds from the inside, using a needle and thread through the endoscope.
Why is it so revolutionary?
Until recently, closing large defects inside the digestive tract was extremely difficult. Traditional clips didn't hold well in large areas, and many patients needed open surgery for complications. Endoscopic suturing changes the game because:
- • It allows durable and resistant closures like real surgical sutures
- • Uses absorbable threads that dissolve on their own in 3-4 months
- • Requires no external incisions, only endoscopy
- • Drastically reduces postoperative complications
The Sutuart System: The technology that makes it possible
To understand how this revolutionary technique works, let me show you the device that makes the magic possible: the Sutuart system from Olympus.
The Sutuart system: a rotatable grasping forceps holding a curved needle, allowing precise sutures inside the digestive tract
Main components of Sutuart
Rotatable grasping forceps
The key piece of the system. These forceps can rotate 360 degrees, allowing me to position the needle at the exact angle I need to properly penetrate the tissue.
Curved needle
Just like the surgical needles used by surgeons, but specifically designed for endoscopy. Its curvature allows controlled "penetration" of the tissue.
Absorbable thread
The thread used is the same type used in internal surgery: it dissolves on its own in 3-4 months, just enough time for the wound to heal completely.
Step-by-step diagram: how endoscopic hand-suturing is performed from needle insertion to complete defect closure
How is the suturing performed?
The procedure is fascinating. As you can see in the diagram above, the process is similar to sewing with needle and thread, but performed entirely through endoscopy:
- Positioning: I place the endoscope in front of the defect I want to close
- Needle insertion: With the rotatable forceps, I penetrate one edge of the defect with the needle
- Thread passage: The needle carries the absorbable thread with it
- Second penetration: I penetrate the opposite edge of the defect
- Knotting: I perform an endoscopic knot to close the tissue
- Repetition: I repeat the process until the defect is completely closed
All of this is done without any external incision, only through the endoscope, as if I were performing a regular gastroscopy.
When do I use endoscopic suturing?
In my daily practice as an advanced endoscopy specialist, I use endoscopic suturing with Sutuart in multiple situations. Let me explain the most important ones clearly:
After Endoscopic Submucosal Dissection (ESD)
Endoscopic submucosal dissection is a technique that allows removal of large lesions (complex polyps, early cancers) in one piece. The problem is that it leaves an "ulcer" or defect on the stomach or colon wall.
My experience: I use suturing with Sutuart to close these ulcers, especially when they are large or in patients taking anticoagulants. This dramatically reduces the risk of delayed bleeding (appearing days later).
During Peroral Endoscopic Myotomy (POEM)
POEM is the most advanced treatment for achalasia (a problem where the esophagus doesn't relax properly). It involves creating a "tunnel" under the esophageal mucosa to cut the malfunctioning muscle.
My experience: I close the tunnel entrance with endoscopic suturing at the end of POEM. This ensures an airtight closure, prevents reflux of content into the tunnel, and reduces infectious complications.
Bleeding Prevention after Endoscopic Mucosal Resection (EMR)
Endoscopic mucosal resection is a procedure to remove polyps by lifting the mucosa. Although simpler than ESD, it can also leave defects that bleed.
My experience: In large mucosectomies or high-risk patients (anticoagulated, elderly), closing the defect with suturing practically eliminates the risk of delayed bleeding.
Treatment of Complications without Surgery
Endoscopic suturing also allows us to treat complications that previously required emergency surgery:
- • Endoscopic perforations: If a small hole is made in the wall during a procedure, we can close it immediately with suturing.
- • Digestive fistulas: Abnormal connections between the intestine and other organs can be closed endoscopically.
- • Anastomotic dehiscence: When a surgical junction opens, we can repair it without reoperation.
Importance: This means that many patients who previously needed emergency surgery can now be resolved with endoscopy, with much less aggression and faster recovery.
Need an advanced endoscopy procedure?
As an expert in advanced endoscopic techniques, I can offer you the most modern and least invasive options for your case.
Book AppointmentA Real Case: Early Gastric Cancer Treated with ESD and Suturing
To help you better understand how this works in practice, let me show you a real case I recently treated. The images below show the complete procedure:
Complete sequence: initial cancerous lesion, ulcer after ESD, closure with Sutuart, and resected specimen pinned for analysis
Step-by-step case explanation:
Upper left image: The initial lesion
You can see a reddish lesion in the stomach, an early gastric cancer (very early stage). This type of cancer, when detected this early, can be completely cured with endoscopy, without needing to remove the stomach.
Upper right image: The ulcer after ESD
After removing the lesion with endoscopic submucosal dissection, a large defect remains on the stomach wall. This "wound" is the ulcer, and if not closed properly, it can bleed days later or even perforate.
Lower left image: Closure with Sutuart
Here you see the result after closing the ulcer with the Sutuart suturing system. You can see several suture points (the absorbable threads) that have completely closed the defect. It's as if the wound never existed. This airtight closure prevents bleeding and complications.
Lower right image: The resected specimen
This is the cancerous lesion we removed, pinned on a rubber surface for microscopic examination. By extracting it in one piece (thanks to ESD), the pathologist can perfectly analyze the margins and confirm that all the cancer was removed.
Case outcome
The patient recovered perfectly, with no bleeding or complications. The analysis confirmed that the cancer was completely resected with clear margins. No surgery was needed, the stomach remained intact, and the patient returned to normal life within a few days.
This is the power of combining ESD with endoscopic suturing: complete oncological cure with minimal invasion.
What does science say? The evidence supporting the technique
As a physician, I cannot rely solely on my personal experience. I need the techniques I use to be backed by solid scientific studies. Endoscopic hand-suturing has impressive evidence:
Multiple studies show that endoscopic closure with hand-suturing successfully closes mucosal defects in more than 95% of cases, even in large defects after gastric ESD.
In studies with anticoagulated patients (high risk), when the sutured closure remained intact, the incidence of postoperative bleeding was zero. No bleeding at all!
Endoscopic suturing significantly reduces the risk of post-ESD bleeding compared to not closing or using clips alone, especially in patients on antithrombotic therapy.
The threads used are completely absorbable and dissolve naturally in 3-4 months, more than enough time for the wound to heal completely.
Additional important evidence
- • Improved healing: Animal model studies show that endoscopic suturing promotes faster and more complete histological healing of the mucosal defect.
- • Demonstrated safety: No serious adverse events directly related to the suturing technique have been reported in published studies.
- • Feasibility in high-risk patients: The technique is especially useful in patients taking anticoagulants or antiplatelet agents, where bleeding risk is higher.
- • Applicable in multiple scenarios: Evidence supports its use not only in gastric ESD, but also in colon, esophagus, and in treating complications like perforations.
Advantages of endoscopic suturing over other techniques
Before endoscopic hand-suturing existed, we used other closure techniques. Why is suturing superior?
| Feature | Metal Clips | Over-the-scope clips (OTSC) | Hand-Suturing (Sutuart) |
|---|---|---|---|
| Large defects | ❌ Limited | ⚠️ Possible | ✅ Excellent |
| Closure durability | ⚠️ Medium | ✅ Good | ✅ Excellent |
| Closure precision | ⚠️ Limited | ⚠️ Moderate | ✅ Maximum |
| Versatility | ✅ Good | ⚠️ Limited | ✅ Maximum |
| Complete absorption | ❌ No | ❌ No | ✅ Yes (3-4 months) |
| Learning curve | ✅ Short | ⚠️ Medium | ⚠️ Long (requires training) |
Most importantly: What does this mean for you as a patient?
- • Fewer complications: Lower risk of bleeding, perforation, or need for reoperation
- • Faster recovery: By preventing complications, you return to normal life sooner
- • Avoid surgery: Many situations that previously required major surgery can now be resolved endoscopically
- • Greater safety: Especially if you take anticoagulants or antiplatelet agents
- • More ambitious treatments: Allows removal of larger lesions safely
Need an advanced endoscopic procedure?
As an advanced endoscopy specialist with extensive experience in endoscopic suturing, I can offer you the most modern and safe techniques for your particular case.
Book AppointmentThe future of endoscopic suturing: Where are we heading?
Endoscopic hand-suturing is already revolutionary, but this is just the beginning. The field is evolving rapidly, and in the coming years we will see even more impressive advances:
Robotic suturing systems
Robotic platforms are being developed that will make endoscopic suturing even easier, faster, and more accessible to more endoscopists.
Smart materials
Threads with antimicrobial properties, drug-releasing capabilities, or that stimulate healing are under development.
New applications
Beyond the digestive tract, endoscopic suturing is being explored for other applications: biliary tract, pancreas, obesity treatment, etc.
Training and democratization
As more specialists are trained in this technique, it will be available to more patients in more centers.
My commitment to innovation
As a European advisor for Olympus and trainer in advanced endoscopy, I have access to the latest innovations in endoscopic suturing. Additionally, I actively participate in training other specialists in Spain and Europe in these techniques.
My goal is for my patients to always benefit from the most advanced and safe that medicine can offer, maintaining a balance between innovation and safety backed by solid scientific evidence.
Final Message: A new era in endoscopy
What you should remember
Endoscopic hand-suturing with Sutuart represents a qualitative leap in how we treat complex digestive problems.
In my daily practice, I have seen how this technique literally transforms patients' lives. People who previously needed complex surgeries with long hospitalizations now go home in 2-3 days. Patients who lived with constant fear of bleeding now have the peace of mind of an airtight and safe closure.
As an advanced endoscopy specialist, my commitment is to always offer you the most modern, safe, and evidence-based techniques. Endoscopic hand-suturing is, without a doubt, one of the most powerful tools we currently have to care for your digestive health with minimal invasion.
If you have any condition that could benefit from these advanced techniques, I will be happy to evaluate your case and offer you the best personalized treatment.
Scientific References
- 1. Goto O, Oyama T, Ono H, et al. Endoscopic Hand-Suturing Is Feasible, Safe, and May Reduce Bleeding Risk After Gastric Endoscopic Submucosal Dissection: A Multicenter Pilot Study. Gastrointestinal Endoscopy. 2020;91(5):1195-1202. doi:10.1016/j.gie.2019.12.046
- 2. Goto O, Sasaki M, Akimoto T, et al. Endoscopic Hand-Suturing for Defect Closure After Gastric Endoscopic Submucosal Dissection: A Pilot Study in Animals and in Humans. Endoscopy. 2017;49(8):792-797. doi:10.1055/s-0043-110668
- 3. Akimoto T, Goto O, Sasaki M, et al. Endoscopic Hand Suturing for Mucosal Defect Closure After Gastric Endoscopic Submucosal Dissection May Reduce the Risk of Postoperative Bleeding in Patients Receiving Antithrombotic Therapy. Digestive Endoscopy. 2022;34(1):123-132. doi:10.1111/den.14045
- 4. Akimoto T, Goto O, Sasaki M, et al. Endoscopic Suturing Promotes Healing of Mucosal Defects After Gastric Endoscopic Submucosal Dissection: Endoscopic and Histologic Analyses in In Vivo Porcine Models. Gastrointestinal Endoscopy. 2020;91(5):1172-1182. doi:10.1016/j.gie.2019.12.032
Dr. Pedro de María Pallarés
Digestive System Specialist • Advanced Endoscopy Expert
Hospital Universitario La Paz • INMEQ
🏆 TopDoctors Awards 2024 • Member SEPD, SEED, ESGE