A novel endoscopic purse-string suture technique, "loop 9", for gastrointestinal defect closure: a pilot study

Background This study aimed to assess the feasibility and efficacy of the novel loop 9 method of gastrointestinal (GI) defect closure. Methods 20 patients underwent a GI procedure that required defect closure. Loop 9 can be delivered through a single instrument channel (3.2mm) and released at the defect site. After it has been anchored by two clips positioned on opposite sides of the defect edge, the loop 9 is tightened by pulling the end of the suture intraluminally using biopsy forceps. Additional clips are placed to achieve complete closure. The primary outcome was complete closure rate. The secondary outcomes were closure time, sustained closure rate, and adverse events. Results Complete closure was achieved in 100% of cases. The mean size of the mucosal defects was 17.5mm (range 10-55mm). The median closure time was 14 minutes. The sustained closure rate was 90%. No adverse events were noted. Conclusions The loop 9 technique is feasible and effective in achieving complete and sustained closure of therapeutic endoscopy-related GI defects.