{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T22:41:05Z","timestamp":1792795265682,"version":"4.5.0"},"reference-count":16,"publisher":"Georg Thieme Verlag KG","issue":"11","license":[{"start":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T00:00:00Z","timestamp":1783382400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Endoscopy"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Endoscopic closure techniques are essential for management of endoscopic defects and help prevent delayed bleeding and perforation. This study reports clinical outcomes of an endoscopic hand-suturing system (EHS) for defect closure.<\/jats:p>\n                  <jats:p>This multicenter European registry study evaluated all procedures using EHS from 14 centers. The primary end point was technical success, defined as complete defect closure without additional closure techniques. Secondary end points were in-hospital clinical success (absence of post-interventional complications), overall defect closure rate (closure achieved with additional devices), and suturing speed.<\/jats:p>\n                  <jats:p>Between February 2023 and January 2026, 338 procedures were included. Indications comprised endoscopic submucosal dissection (n = 240), endoscopic intermuscular dissection (n = 32), gastric peroral endoscopic myotomy (n = 41), fistula (n = 10), endoscopic mucosal resection (n = 6), submucosal tunneling endoscopic resection (n = 3), nonexposed endoscopic wall inversion surgery (n = 2), and anastomotic leak, perforation, endoscopic full-thickness resection, and endoscopic hemostasis (all n = 1). Median defect size was 35 mm (range 4\u2013155 mm) and median suturing time was 25 minutes (range 4\u2013120). Technical success was 96.2% (325\/338). Overall defect closure rate was 96.7% (327\/338). In-hospital clinical success was 97.9% (331\/338). Defect size did not predict suturing time in the size-adjusted model, indicating that procedural complexity was not explained by size alone. Procedure-related adverse events occurred in 5\/338 (1.5%); overall adverse event rate was 10\/338 (3.0%).<\/jats:p>\n                  <jats:p>EHS demonstrated high technical and in-hospital clinical success with a low short-term adverse event rate. Further studies are needed to assess performance with complex defects.<\/jats:p>","DOI":"10.1055\/a-2909-3681","type":"journal-article","created":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T22:47:20Z","timestamp":1783464440000},"page":"1199-1210","source":"Crossref","is-referenced-by-count":1,"title":["Technical and clinical success of endoscopic hand-suturing: a European multicenter study"],"prefix":"10.1055","volume":"58","author":[{"given":"Mousa","family":"Ayoub","sequence":"additional","affiliation":[{"name":"St. Josef-Hospital Bochum, Ruhr University Bochum, Germany","place":["Bochum"],"department":["Department of Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8299-9561","authenticated-orcid":false,"given":"Esma Z.","family":"K\u0131z\u0131laslan","sequence":"additional","affiliation":[{"name":"St. Josef-Hospital Bochum, Ruhr University Bochum, Germany","place":["Bochum"],"department":["Department of Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra","family":"Nagl","sequence":"additional","affiliation":[{"name":"University Hospital Augsburg, Germany","place":["Augsburg"],"department":["III. Medical Department"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1002-7202","authenticated-orcid":false,"given":"Fatih","family":"Aslan","sequence":"additional","affiliation":[{"name":"Koc University Hospital, Turkey","place":["Istanbul"],"department":["Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3071-0428","authenticated-orcid":false,"given":"Torsten","family":"Beyna","sequence":"additional","affiliation":[{"name":"Evangelisches Krankenhaus D\u00fcsseldorf, Germany","place":["D\u00fcsseldorf"],"department":["Department of Gastroenterology and Hepatology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oscar","family":"Cahyadi","sequence":"additional","affiliation":[{"name":"St. Josef-Hospital Bochum, Ruhr University Bochum, Germany","place":["Bochum"],"department":["Department of Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8923-6428","authenticated-orcid":false,"given":"Seung-Hun","family":"Chon","sequence":"additional","affiliation":[{"name":"University Hospital of Cologne, Germany","place":["Cologne"],"department":["Department of General, Visceral, Thoracic, and Transplant Surgery"]},{"name":"University Hospital of Cologne, Germany","place":["Cologne"],"department":["Department of Gastroenterology and Hepatology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Werner","family":"Dolak","sequence":"additional","affiliation":[{"name":"Medical University of Vienna, Austria","place":["Vienna"],"department":["Internal Medicine III, Div. of Gastroenterology and Hepatology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacek","family":"Drzewiecki","sequence":"additional","affiliation":[{"name":"Provincial Integrated Hospital, Poland","place":["Elblag"],"department":["Department of Internal Medicine and Gastroenterology"]},{"name":"Collegium Medicum Nicolaus Copernicus University, Poland","place":["Torun"],"department":["Department of General, Gastroenterological and Oncological Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2548-1749","authenticated-orcid":false,"given":"Peter","family":"Ewald","sequence":"additional","affiliation":[{"name":"St. Josef-Hospital Bochum, Ruhr University Bochum, Germany","place":["Bochum"],"department":["Department of Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4507-5770","authenticated-orcid":false,"given":"Stefan K.","family":"G\u00f6lder","sequence":"additional","affiliation":[{"name":"Ostalb Hospital Aalen, Germany","place":["Aalen"],"department":["Department of Gastroenterology, Hematology\/Oncology and Pulmonology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-5386-1995","authenticated-orcid":false,"given":"Przemys\u0142aw","family":"Kasprzyk","sequence":"additional","affiliation":[{"name":"Brzeziny Specialist Hospital, Poland","place":["\u0141\u00f3d\u017a"],"department":["Endoscopy and Bariatric Surgery Center"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0683-2126","authenticated-orcid":false,"given":"Arjun D.","family":"Koch","sequence":"additional","affiliation":[{"name":"Erasmus MC Cancer Institute, Netherlands","place":["Rotterdam"],"department":["Department of Gastroenterology and Hepatology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos","family":"Kouladouros","sequence":"additional","affiliation":[{"name":"Charite University Hospital Berlin, Germany","place":["Berlin"],"department":["Central Inderdisciplinary Endoscopy, Department of Hepatology and Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0029-9885","authenticated-orcid":false,"given":"Ra\u00fal","family":"Honrubia L\u00f3pez","sequence":"additional","affiliation":[{"name":"Hospital Universitario Infanta Sofia, Spain","place":["San Sebastian de los Reyes"],"department":["Department of Gastroenterology"]},{"name":"Universidad Europea de Madrid Campus de Villaviciosa de Od\u00f3n, Spain","place":["Madrid"],"department":["Department of Medicine, School of Medicine, Health and Sports"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-0568-7188","authenticated-orcid":false,"given":"Annemijn D.I.","family":"Maan","sequence":"additional","affiliation":[{"name":"Erasmus MC Cancer Institute, Netherlands","place":["Rotterdam"],"department":["Department of Gastroenterology and Hepatology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedro","family":"De Mar\u00eda","sequence":"additional","affiliation":[{"name":"Hospital University of La Paz, Spain","place":["Madrid"],"department":["Department of Digestive Diseases"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6476-1680","authenticated-orcid":false,"given":"Khanh Do-Cong","family":"Pham","sequence":"additional","affiliation":[{"name":"Haukeland University Hospital, Norway","place":["Bergen"],"department":["Department of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel R.","family":"Quast","sequence":"additional","affiliation":[{"name":"St. Josef-Hospital Bochum, Ruhr University Bochum, Germany","place":["Bochum"],"department":["Department of Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1802-812X","authenticated-orcid":false,"given":"Pedro J.","family":"Ros\u00f3n","sequence":"additional","affiliation":[{"name":"Quir\u00f3n Hospital, Spain","place":["M\u00e1laga"],"department":["Department of Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2852-6042","authenticated-orcid":false,"given":"Enrique","family":"Rodriguez de Santiago","sequence":"additional","affiliation":[{"name":"Hospital Universitario Ram\u00f3n y Cajal, Universidad de Alcal\u00e1, IRYCIS, Spain","place":["Madrid"],"department":["Gastroenterology and Hepatology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofia P.","family":"Carbonell","sequence":"additional","affiliation":[{"name":"Hospital Universitario Ram\u00f3n y Cajal. Universidad de Alcal\u00e1, IRYCIS, Spain","place":["Madrid"],"department":["Gastroenterology and Hepatology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2255-7032","authenticated-orcid":false,"given":"Markus W.","family":"Scheppach","sequence":"additional","affiliation":[{"name":"University Hospital Augsburg, Germany","place":["Augsburg"],"department":["III. Medical Department"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michal","family":"Spychalski","sequence":"additional","affiliation":[{"name":"Brzeziny Specialist Hospital, Poland","place":["Brzeziny"],"department":["Endoscopy and Bariatric Surgery Center"]},{"name":"Medical University of Lodz, Poland","place":["\u0141\u00f3d\u017a"],"department":["Department of Internal Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-1610-3539","authenticated-orcid":false,"given":"Shunya","family":"Takayanagi","sequence":"additional","affiliation":[{"name":"Haukeland University Hospital, Norway","place":["Bergen"],"department":["Department of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian Rafael","family":"Torres Reyes","sequence":"additional","affiliation":[{"name":"St. Josef-Hospital Bochum, Ruhr University Bochum, Germany","place":["Bochum"],"department":["Department of Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Veiser","sequence":"additional","affiliation":[{"name":"Evangelisches Krankenhaus D\u00fcsseldorf, Germany","place":["D\u00fcsseldorf"],"department":["Department of Gastroenterology and Hepatology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin M.","family":"Walter","sequence":"additional","affiliation":[{"name":"University Hospital Ulm, Germany","place":["Ulm"],"department":["Department of Internal Medicine I"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jochen","family":"Weigt","sequence":"additional","affiliation":[{"name":"Otto-von-Guericke Universitiy, Germany","place":["Magdeburg"],"department":["Department of Gastroenterology, Hepatology and Infectious diseases"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Zeidler","sequence":"additional","affiliation":[{"name":"St. Josef-Hospital Bochum, Ruhr University Bochum, Germany","place":["Bochum"],"department":["Department of Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helmut","family":"Messmann","sequence":"additional","affiliation":[{"name":"University Hospital Augsburg, Germany","place":["Augsburg"],"department":["III. Medical Department"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alanna","family":"Ebigbo","sequence":"additional","affiliation":[{"name":"St. Josef-Hospital Bochum, Ruhr University Bochum, Germany","place":["Bochum"],"department":["Department of Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1007\/s11894-024-00952-6","article-title":"Gastric per-oral endoscopy myotomy (G-POEM): tips, tricks, and pitfalls","volume":"27","author":"GE Kim","year":"2025","journal-title":"Curr Gastroenterol Rep"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1159\/000522362","article-title":"Factors related to delayed adverse events of endoscopic submucosal dissection in the duodenum","volume":"41","author":"T Kawamura","year":"2023","journal-title":"Dig Dis"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"216","DOI":"10.1111\/den.14397","article-title":"Clinical and technical outcomes of endoscopic closure of postendoscopic submucosal dissection defects: literature review over one decade","volume":"35","author":"H Kobara","year":"2023","journal-title":"Dig Endosc"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpg.2024.101938","article-title":"How to close mucosal incisions?","volume":"71","author":"R Hustak","year":"2024","journal-title":"Best Pract Res Clin Gastroenterol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"386","DOI":"10.1007\/s11938-018-0199-6","article-title":"Endoscopic full-thickness defects and closure techniques","volume":"16","author":"DTH de Moura","year":"2018","journal-title":"Curr Treat Options Gastroenterol"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1159\/000549619","article-title":"Endoscopic closure techniques for perforations, leaks, and fistulae: review article","author":"ECJ Damasceno","year":"2025","journal-title":"GE Port J Gastroenterol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"521","DOI":"10.4253\/wjge.v12.i12.521","article-title":"Recent advances in third space or intramural endoscopy","volume":"12","author":"AB Shanbhag","year":"2020","journal-title":"World J Gastrointest Endosc"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"792","DOI":"10.1055\/a-1222-3191","article-title":"Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement \u2013 update 2020","volume":"52","author":"GA Paspatis","year":"2020","journal-title":"Endoscopy"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1055\/a-2031-0874","article-title":"Endoscopic submucosal dissection techniques and technology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review","volume":"55","author":"D Lib\u00e2nio","year":"2023","journal-title":"Endoscopy"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1016\/j.vgie.2018.07.003","article-title":"Successful removal of duodenal submucosal tumors with endoscopic submucosal dissection","volume":"3","author":"PS Ge","year":"2018","journal-title":"VideoGIE"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpg.2024.101915","article-title":"Endoscopic suturing and clipping devices for defects in the GI tract","volume":"70","author":"A Papaefthymiou","year":"2024","journal-title":"Best Pract Res Clin Gastroenterol"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"1245","DOI":"10.1111\/den.14808","article-title":"Endoscopic hand suturing using a modified through-the-scope needle holder for mucosal closure after colorectal endoscopic submucosal dissection: prospective multicenter study (with video)","volume":"36","author":"T Uozumi","year":"2024","journal-title":"Dig Endosc"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"E507","DOI":"10.1055\/a-2284-9492","article-title":"Potential for expanded application of endoscopic hand suturing: a pilot study of 15 cases","volume":"12","author":"K Higuchi","year":"2024","journal-title":"Endosc Int Open"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"792","DOI":"10.1055\/s-0043-110668","article-title":"Endoscopic hand-suturing for defect closure after gastric endoscopic submucosal dissection: a pilot study in animals and in humans","volume":"49","author":"O Goto","year":"2017","journal-title":"Endoscopy"},{"key":"ref18","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1016\/j.gie.2024.08.001","article-title":"Feasibility of a new endoscopic suturing device: a first Western experience (with video)","volume":"101","author":"MW Scheppach","year":"2025","journal-title":"Gastrointest Endosc"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"446","DOI":"10.1016\/j.gie.2009.10.027","article-title":"A lexicon for endoscopic adverse events: report of an ASGE workshop","volume":"71","author":"PB Cotton","year":"2010","journal-title":"Gastrointest Endosc"}],"container-title":["Endoscopy"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2909-3681.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T22:30:50Z","timestamp":1792794650000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2909-3681"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,7]]},"references-count":16,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2026,10,23]]},"published-print":{"date-parts":[[2026,11]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2909-3681","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0013-726X","1438-8812"],"issn-type":[{"value":"0013-726X","type":"print"},{"value":"1438-8812","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,7,7]]},"published":{"date-parts":[[2026,7,7]]}}}