Randomized Controlled Trial
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jun 27, 2025; 17(6): 106069
Published online Jun 27, 2025. doi: 10.4240/wjgs.v17.i6.106069
Comparison between interrupted closure technique and traditional closure technique in endoscopic full-thickness resection for treating gastric subepithelial lesions
Meng Zhang, Jiao Liu, Yun-Peng Dong, Qian Zhao, Mei-Ling Lin, Teng-Jiao Gao, Jia-Li Feng, Yi-Fei Wang, Yu-Fan Guo, Zhen Wang, Wen Jia, Zhuo Yang
Meng Zhang, Jiao Liu, Yun-Peng Dong, Qian Zhao, Mei-Ling Lin, Teng-Jiao Gao, Jia-Li Feng, Yi-Fei Wang, Yu-Fan Guo, Zhen Wang, Wen Jia, Zhuo Yang, Department of Endoscopy, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
Yun-Peng Dong, Department of Gastroenterology, Liaoning Jinqiu Hospital (Liaoning Geriatric Research Institute), Shenyang 110840, Liaoning Province, China
Mei-Ling Lin, Department of Digestive Endoscopy, Shenyang Coloproctology Hospital, Shenyang 110840, Liaoning Province, China
Co-first authors: Meng Zhang and Jiao Liu.
Co-corresponding authors: Wen Jia and Zhuo Yang.
Author contributions: Zhang M and Liu J conceptualized and designed the study, drafted the manuscript, and approved the final version for publication; Both authors have made crucial and indispensable contributions towards the completion of the project and thus qualified as the co-first authors of the paper. Dong YP, Zhao Q and Lin ML were responsible for patient screening, enrollment and collection of clinical data; Gao TJ, Feng JL, Wang YF, Guo YF and Wang Z performed Data analysis; Jia W and Yang Z were responsible for patient recruitment, treatment, study supervision, manuscript revision, and submission. Both Jia W and Yang Z have played important and indispensable roles in the experimental design, data interpretation and manuscript preparation as the co-corresponding authors. Liu J and Yang Z applied for and obtained the funds for this research project.
Supported by the Shenyang Science and Technology, No. 22-321-32-15; and Department of Science and Technology of Liaoning Province, No. 2023JH2/101600015.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of General Hospital of Northern Theater Command, No. Y (2023) 167.
Clinical trial registration statement: This study is registered at Chinese Clinical Trial Registry (https://www.chictr.org.cn). The registration identification number is ChiCTR2400086500.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhuo Yang, MD, PhD, Associate Chief Physician, Professor, Department of Endoscopy, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenhe District, Shenyang 110840, Liaoning Province, China. yangzhuocy@163.com
Received: February 17, 2025
Revised: March 17, 2025
Accepted: April 28, 2025
Published online: June 27, 2025
Processing time: 104 Days and 23.2 Hours
Abstract
BACKGROUND

Gastric subepithelial lesions (SELs) are elevated lesions originating from the muscularis mucosa, submucosa, or muscularis propria, and may also include extraluminal lesions. For small SELs (less than 5 cm), complete endoscopic excision is the preferred treatment. Endoscopic full-thickness resection (EFTR) has proven to be an effective approach.

AIM

To evaluate the efficacy of the interrupted closure technique compared to the traditional closure technique in EFTR for gastric SELs.

METHODS

This single-center, prospective, randomized controlled trial was conducted at a tertiary hospital from September 2023 to September 2024. A total of 90 patients who underwent EFTR for gastric SELs were randomly allocated to either the interrupted closure group (n = 44) or the traditional closure group (n = 46).

RESULTS

All patients had complete resection and wound closure without any severe postoperative complications. The incidence of intraoperative gas-related complications was significantly lower in the interrupted closure group than in the traditional closure group (2.27% vs 26.09%, P = 0.001), demonstrating interrupted closure technique can reduce the incidence of gas-related issues. Statistical analysis revealed that the incidence of postoperative infection was significantly lower in the experimental group than in the control group (15.91% vs 41.30%, P = 0.008). Additionally, the median duration of antibiotic use was lower in the experimental group (3.5 days vs 5 days, P = 0.013). Abdominal pain levels on postoperative days 1 and 4 were also lower in the experimental group compared to the control group (P < 0.001).

CONCLUSION

The interrupted closure technique in EFTR for treating gastric SELs is safe and effective, reducing the incidence of intraoperative gas complications and postoperative infections.

Keywords: Endoscopic full-thickness resection; Interrupted closure; Gastric subepithelial lesion; Gas complication; Postoperative infection

Core Tip: The interrupted closure technique involves performing a two-thirds circumferential full-thickness incision around the diseased gastric wall, followed by the immediate closure of either the proximal or distal end of the defect using metallic clips. With minimal necessary exposure, lesion dissection and defect closure are performed alternately until complete tumor resection and wound closure are achieved. Our study findings demonstrate that this technique is an effective approach for the treatment of gastric subepithelial lesions, significantly reducing the incidence of intraoperative gas-related complications and postoperative infections compared to traditional endoscopic full-thickness resection.