A Novel Flexible Endoscopic C-shaped Suturing Device for Gastrointestinal Wound Closure: First Survival Study in Pigs (With Video).

Background and study aims Flexible endoscopic suturing for gastrointestinal wounds is technically challenging and has limited clinical adoption. We developed a flexible endoscopic C-shaped suturing device (E-CSD) and conducted a preliminary pilot study to assess its feasibility and safety. Methods The novel E-CSD was used to close wounds in live pigs following endoscopic full-thickness resection and endoscopic submucosal dissection. Primary outcomes included wound size and location, procedure time, technical success rate, intraoperative and postoperative complications (e.g., device-related mucosal damage, bleeding, and perforation), and wound healing status, including suture maintenance, during a 30-day follow-up period with weekly endoscopy. Results Four wounds were established in two pigs, including two perforated wounds (one each in the stomach and rectum) and two nonperforated wounds (one each in the stomach and colon). The wound sizes ranged from 1.5 × 3.5 to 4.0 × 5.0 cm. Complete closure was achieved in all cases (4/4, 100%), with a mean suturing time of 11 min (range 8-16). No significant complications were reported during the 30-day follow-up period. One case showed minor dehiscence on postoperative day 7, whereas the other wounds remained technically closed and healed progressively into scars. Conclusions The newly developed E-CSD successfully closed both perforated and nonperforated gastrointestinal wounds in live pigs with no significant complications during the 30-day follow-up period. As the first animal study using this method, the findings provide preliminary evidence of the feasibility and safety of E-CSD for gastrointestinal wound closure.