Complete Endoscopic Closure of Gastric Defects Using a Full-thickness Tissue Plicating Device

Overview

Journal J Gastrointest Surg

Specialty Gastroenterology

Date 2007 Oct 25

PMID 17957435

Citations 12

Authors

Michael F McGee

Jeffrey M Marks

Judy Jin

Christina Williams

Amitabh Chak

Steve J Schomisch

Jamie Andrews

Shoichi Okada

Jeffrey L Ponsky

Affiliations

Soon will be listed here.

Abstract

Obtaining endolumenal closure of hollow visceral defects may complement conventional, incision-based, surgical alternatives and benefit the experimental field of natural orifice translumenal endoscopic surgery (NOTES). Endoscopic tissue plicating devices (TPD) represent a promising closure technology; however, the long-term integrity of resultant closures is uncertain. Swine (n=10) underwent survival transgastric NOTES peritoneoscopy procedures with TPD gastrotomy closure while device performance and closure integrity were evaluated. Following uncomplicated procedures, no animals revealed leakage on upper gastrointestinal contrast fluoroscopy immediately following closure and on postoperative days 2 and 7. Necropsy performed on the 14th postoperative day revealed a subclinical colonic injury for one animal; the remaining nine animals had no complications. Gastric burst testing revealed the strength of closure was comparable to that of nonsurgical control stomachs (85.1 vs. 85.3 mm Hg, p=0.98). For six of nine (66%) TPD animals, bursting occurred remote to the closure site in nonsurgical tissue, indicating that closure strength equaled that of native tissue. Endoscopic TPD closure of standardized NOTES gastric defects results in strong, leak-proof closure; however, injuries can occur. These findings support evaluation of TPD closure in human trials involving noncontrolled gastric defects.

Citing Articles

Prospective randomized comparison of gastrotomy closure associating tunnel access and over-the-scope clip (OTSC) with two other methods in an experimental ex vivo setting.

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Endoscopic ultrasound-assisted direct peritoneal visualization with a small-caliber scope: A proof of concept study in a swine model.

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NOTES for the management of an intra-abdominal abscess: transcolonic peritonoscopy and abscess drainage in a canine model.

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Efficacy and safety of transgastric closure in natural orifice transluminal endoscopic surgery using the OTSC system and T-bar sutures: a survival study in a porcine model.

Suhail A, Marvik R, Halgunset J, Kuhry E Surg Endosc. 2012; 26(10):2950-4.

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Transgastric small bowel resection with the new multitasking platform EndoSAMURAI™ for natural orifice transluminal endoscopic surgery.

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