Comparing the Safety and Efficacy of Overstitch, X-Tack, and Endoscopic Hand Suturing for Closure of Gastrointestinal Defects After Endoscopic Resection: A systematic review and Meta-Analysis.

Abstract

Background and aims: Data comparing the efficacy and safety of Overstitch, X-Tack, and Endoscopic Hand Suturing (EHS) for closure of gastrointestinal defects after endoscopic resection is limited. We conducted a meta-analysis of the available data.

Methods: Online databases were searched for studies evaluating different closure systems for gastrointestinal defects. The outcomes of interest were technical success, clinical success, and adverse events. Pooled proportions were calculated.

Results: A total of 15 studies (4 for EHS, 7 for Overstitch and 5 for X-Tack) were included. The pooled outcomes for EHS were: technical success 98%, clinical success 96%, adverse events 2%, bleeding 3% and perforation 1%. The pooled outcomes for Overstitch were: technical success 93%, clinical success 93%, adverse events 6%, bleeding 3% and perforation 3%. The pooled outcomes with X-Tack were: technical success 95%, clinical success 94%, adverse events 3%, bleeding 2% and perforation 1%.

Conclusions: All 3 closure methods showed comparable high technical and clinical success rates. EHS and X-tack had lower adverse event rates than Overstitch. Future direct comparison studies would be needed to corroborate our findings.