Clinical Endoscopy

Original Article

Feasibility of Zeosuture M for gastric endoscopic submucosal dissection defect closure during anticoagulation: a preclinical porcine study from Japan: Yohei Minato, Tadateru Maehata, Yoshinori Sato, Fumio Itoh, Ken Ohata, Keisuke Tateishi; Received September 3, 2025 Accepted October 23, 2025 Published online February 24, 2026; DOI: https://doi.org/10.5946/ce.2025.329 [Epub ahead of print]

Graphical Abstract Abstract PDF Supplementary Material PubReader ePub: Background
/Aims: Endoscopic submucosal dissection (ESD) in patients undergoing anticoagulant therapy carries a risk of delayed bleeding. Zeosuture M is a novel endoscopic suturing system designed for secure mucosal closure. This study evaluated the feasibility of Zeosuture M and the short-term clinical course after mucosal closure in a warfarinized porcine ESD model.
Methods
Gastric ESD was performed in four pigs under warfarin anticoagulation (three defects per animal; 12 sites). Warfarin administration began 15 days before ESD. All defects were closed using Zeosuture M. Follow-up endoscopy was performed on postoperative days (POD) 1, 2, 4, and 8. Necropsy was conducted on POD 8.
Results
Technical success was 100% (12/12). The mean specimen size was 27.5±3.4 mm, mean number of stitches 3.6±0.7, closure time 28.1±8.0 minutes, and time per stitch 8.0 minutes. No uncontrolled intraprocedural bleeding, delayed hemorrhage, perforation, or peritonitis occurred. Partial loss of apposition was observed on POD 4, and all sites reopened by POD 8 without adverse clinical events.
Conclusions
Zeosuture M provided early stabilization of ESD ulcers during continuous anticoagulation, enabling safe traversal of the high-risk period for delayed bleeding. This represents one of the first preclinical warfarinized porcine evaluations and suggests potential applicability in high-risk patients.

Brief Report

The "Two-Sword Fencing" Technique in Endoscopic Submucosal Dissection: Toshihiro Nishizawa, Toshio Uraoka, Yasutoshi Ochiai, Hidekazu Suzuki, Osamu Goto, Ai Fujimoto, Tadateru Maehata, Takanori Kanai, Naohisa Yahagi; Clin Endosc 2015;48(1):85-86. Published online January 31, 2015; DOI: https://doi.org/10.5946/ce.2015.48.1.85

Citations

Citations to this article as recorded by

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