First experience of endoscopic suturing of gastric insufficiency using the Apollo OverStitch system

Objective of the study. To present the experience of successfully treating a patient with gastric stalk wall suture failure after proximal gastrectomy with lower thoracic esophagectomy using an endoluminal suture device. Clinical case. A 54-year-old patient with a malignant neoplasm of the proximal stomach with extension to the lower thoracic esophagus (cT3N1M0, stage III) was treated at the Oncology Center from July to October 2025. The patient underwent proximal subtotal gastrectomy with resection of the distal stomach. Postoperatively, the patient developed gastric stalk suture failure, requiring pleural drainage and repeat surgery. Results. Endoscopic suturing of the gastric stalk wall defect using the Apollo OverStitch endoluminal suture device resulted in a positive clinical outcome in the treatment of a complex postoperative complication. It should be noted that the patient was restored to oral nutrition within two weeks. Conclusion. Our data demonstrate the high potential of the Apollo Overstitch™ endoluminal suturing device for endoscopic closure of gastric stalk wall defects caused by suture failure.

suture failure, proximal gastrectomy, endoscopic suturing of the defect, device for applying endoluminal suture, endoscopic surgery

1. Seicean R.I., Puscasu D., Gheorghiu A., Pojoga C., Seicean A., Dindelegan G. Anastomotic Leakage after Gastrectomy for Gastric Cancer. J Gastrointestin Liver Dis. 2023;32:526-535. doi:10.15403/jgld-5238.

2. Lee S., Ahn J.Y., Jung H.Y. et al. Clinical outcomes of endoscopic and surgical management for postoperative upper gastrointestinal leakage. Surg Endosc. 2013;27:4232-4240. doi:10.1007/s00464-013-3028-y.

3. Tian P., Liu Y., Bian S., Li M., Zhang M., Liu J., Jin L., Zhang P., Zhang Z.) Laparoscopic Proximal Gastrectomy Versus Laparoscopic Total Gastrectomy for Proximal Gastric Cancer: A Systematic Review and Meta-Analysis. Front. Oncol. 2021 Jan 21;10:607922. doi: 10.3389/fonc.2020.607922.

4. Starkov Yu.G., Vagapov A.I., Dzhantukhanova S.V., Zamolodchikov R.D. Endoluminal endoscopic technologies in the treatment of complications after bariatric interventions. Experimental and Clinical Gastroenterology. 2025;(5): 30-34. (In Russ.) doi: 10.31146/1682-8658-ecg-237-5-30-34.@@ Старков Ю.Г., Вагапов А.И., Джантуханова С.В., Замолодчиков Р.Д. Внутрипросветные эндоскопические технологии в лечении осложнений после бариатрических вмешательств. Экспериментальная и клиническая гастроэнтерология. 2025;(5): 30-34. doi: 10.31146/1682-8658-ecg-237-5-30-34.

5. Starkov Yu.G., Vagapov A.I., Zamolodchikov R.D., Dzhantukhanova S.V. Endoscopic technologies for the treatment of postoperative complications in bariatric patients. Endoscopic Surgery. 2025;31(4):61-67. (In Russ.) doi: 10.17116/endoskop20253104161.@@ Старков Ю.Г., Вагапов А.И., Замолодчиков Р.Д., Джантуханова С.В. Эндоскопические технологии лечения бариатрических пациентов с послеоперационными осложнениями. Эндоскопическая хирургия. 2025;31(4):61-67. doi: 10.17116/endoskop20253104161.

6. Cereatti F., Grassia R., Drago A., Conti C.B., Donatelli G. Endoscopic management of gastrointestinal leaks and fistulae: What option do we have? World J Gastroenterol. 2020 Aug 7;26(29):4198-4217. doi: 10.3748/wjg.v26.i29.4198.

7. Mukewar S., Kumar N., Catalano M. et al. Safety and efficacy of fistula closure by endoscopic suturing: a multi-center study. Endoscopy. 2016;48:1023-1028. doi: 10.1055/s-0042-114036.

8. Granata A., Amata M., Ligresti D., Martino A., Tarantino I., Barresi L., Traina M. Endoscopic management of post-surgical GI wall defects with the overstitch endosuturing system: a single-center experience. Surg Endosc. 2019 doi: 10.1007/s00464-019-07145-7.

9. Kumar N., Thompson C.C. Endoscopic therapy for postoperative leaks and fistulae. Gastrointest Endosc Clin N Am. 2013 Jan;23(1):123-36. doi: 10.1016/j.giec.2012.10.002.

10. Urschel J.D. Esophagogastrostomy anastomotic leaks complicating esophagectomy: a review. Am J Surg. 1995 Jun;169(6):634-40. doi: 10.1016/s0002-9610(99)80238-4.

11. Blencowe N.S., Strong S., McNair A.G., Brookes S.T., Crosby T., Griffin S.M., Blazeby J.M. Reporting of short-term clinical outcomes after esophagectomy: a systematic review. Ann Surg. 2012 Apr;255(4):658-66. doi: 10.1097/SLA.0b013e3182480a6a.

12. Lang H., Piso P., Stukenborg C., Raab R., Jähne J. Management and results of proximal anastomotic leaks in a series of 1114 total gastrectomies for gastric carcinoma. Eur J Surg Oncol. 2000 Mar;26(2):168-71. doi: 10.1053/ejso.1999.0764.

13. Granata A., Amata M., Martino A., De Monte L., Bertani A., Ligresti D., Traina M. Full-thickness gastric plication with Overstitch endoscopic suturing device for postsurgical chronic gastroparesis. Endoscopy. 2020 Jul;52(7): E235-E236. doi: 10.1055/a-1076-0652.

14. Sharaiha R.Z., Kumta N.A., DeFilippis E.M. et al. A Large Multicenter Experience With Endoscopic Suturing for Management of Gastrointestinal Defects and Stent Anchorage in 122 Patients: A Retrospective Review. J Clin Gastroenterol. 2016;50:388-392. doi: 10.1097/MCG.0000000000000336.

15. Mukewar S., Kumar N., Catalano M. et al. Safety and efficacy of fistula closure by endoscopic suturing: a multi-center study. Endoscopy. 2016;48:1023-1028. doi: 10.1055/s-0042-114036.

16. Starkov Yu.G., Vybornyi M.I., Ruchkin D.V., Dzantukhanova S.V., Zamolodchikov R.D., Vorobeva E.A. Endoscopic treatment of esophageal anastomotic leakage using vacuum-assisted closure system. Pirogov Russian Journal of Surgery = Khirurgiya. Zurnal im. N.I. Pirogova. 2019;10:13-20. (In Russ.) doi: 10.17116/hirurgia201910113.@@ Старков Ю.Г., Выборный М.И., Ручкин Д.В., Джантуханова С.В., Замолодчиков Р.Д., Воробьева Е.А. Эндоскопическое лечение несостоятельности пищеводных анастомозов с использованием вакуумно-аспирационной системы. Хирургия. Журнал им. Н.И. Пирогова. 2019;10:13-20. doi: 10.17116/hirurgia201910113.

17. Starkov Yu.G., Dzhantukhanova S.V., Vagapov A.I., Zamolodchikov R.D. The fi rst endoscopic intraluminal gastroplasty in the treatment of a patient with morbid obesity. Experimental and Clinical Gastroenterology. 2025;(5): 127-131. (In Russ.) doi: 10.31146/1682-8658-ecg-237-5-127-131.@@ Старков Ю.Г., Джантуханова С.В., Вагапов А.И., Замолодчиков Р.Д. Первая эндоскопическая внутрипросветная гастропластика в лечении пациента с морбидным ожирением. Экспериментальная и клиническая гастроэнтерология. 2025;(5): 127-131. doi: 10.31146/1682-8658-ecg-237-5-127-131.