Trinity Health Oakland / Wayne State University School of Medicine Pontiac, MI
Yash R. Shah, MD1, Ernesto Calderon-Martinez, MD2, Dushyant S. Dahiya, MD3, Saurabh Chandan, MD4, Manesh Kumar Gangwani, MD5, Hassam Ali, MD6, Raj H. Patel, MD7, Amir H. Sohail, MD, MSc8, Sumant Inamdar, MD9, Rashmi Advani, MD10 1Trinity Health Oakland / Wayne State University School of Medicine, Pontiac, MI; 2University of Texas at Houston, Houston, TX; 3The University of Kansas School of Medicine, Kansas City, KS; 4CHI Health Creighton University Medical Center, Omaha, NE; 5University of Toledo, Toledo, OH; 6ECU Health Medical Center, Greenville, NC; 7St. Mary Medical Center, Bensalem, PA; 8University of New Mexico, Albuquerque, NM; 9University of Arkansas for Medical Sciences, Little Rock, AR; 10Mount Sinai South Nassau, Icahn School of Medicine at Mount Sinai, Oceanside, NY
Introduction: Endoscopic clipping is the standard method for mucosotomy closure in per-oral endoscopic myotomy (POEM) and gastric per-oral endoscopic myotomy (G-POEM), but concerns remain regarding potential leak and long-term complications. Endoscopic suturing offers a potential alternative. This meta-analysis aimed to compare the technical success and outcomes of endoscopic clipping and suturing for mucosotomy closure in E-POEM/G-POEM.
Methods: We conducted a systematic search of databases and extracted data from studies comparing endoscopic clipping and suturing in E-POEM/G-POEM according to PRISMA 2020 guidelines from inception till December 8, 2023. Primary outcomes were technical success (successful closure) and secondary outcomes were cost, procedure time, and complications. Meta-analysis and sensitivity analyses were performed.
Results: Three studies with 91 patients were included. No statistically significant difference was found in technical success rates between clipping and suturing (odds ratio 1.03, 95% confidence interval 0.89-1.19, p=0.50). There was no significant difference in procedure time (SMD (Standardized Mean Difference) -0.73; CI:-170 to 0.23; p =0.13) as well as cost of suturing (SMD 1.85, CI -5.05-1.35, p=0.25) with high heterogeneity (Table 1). Heterogeneity mainly originated from one study and leave-one-out analysis showed insignificant cost difference with moderate heterogeneity. Two studies reported no complications, and one had two complications for clipping and one for suturing.
Discussion: Both endoscopic clipping and suturing achieve successful mucosotomy closure in E-POEM/G-POEM with out any significant difference in the cost and the time between the two closure methods. The outcomes warrant further investigation with larger, randomized controlled trials to determine its role in routine practice.
Note: The table for this abstract can be viewed in the ePoster Gallery section of the ACG 2024 ePoster Site or in The American Journal of Gastroenterology's abstract supplement issue, both of which will be available starting October 27, 2024.
Disclosures:
Yash Shah indicated no relevant financial relationships.
Ernesto Calderon-Martinez indicated no relevant financial relationships.
Dushyant Dahiya indicated no relevant financial relationships.
Saurabh Chandan indicated no relevant financial relationships.
Manesh Kumar Gangwani indicated no relevant financial relationships.
Hassam Ali indicated no relevant financial relationships.
Raj Patel indicated no relevant financial relationships.
Amir H. Sohail indicated no relevant financial relationships.
Sumant Inamdar indicated no relevant financial relationships.
Rashmi Advani indicated no relevant financial relationships.
Yash R. Shah, MD1, Ernesto Calderon-Martinez, MD2, Dushyant S. Dahiya, MD3, Saurabh Chandan, MD4, Manesh Kumar Gangwani, MD5, Hassam Ali, MD6, Raj H. Patel, MD7, Amir H. Sohail, MD, MSc8, Sumant Inamdar, MD9, Rashmi Advani, MD10. P2773 - Endoscopic Clipping vs Suturing for Mucosotomy Closure in E-POEM and G-POEM: A Systematic Review and Meta-Analysis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
