Transoral mucosal excision sutured gastroplasty: a pilot study for GERD and obesity with two-year follow-up.
Bottom Line: An outpatient transoral endoscopic procedure for gastroesophageal reflux disease (GERD) and obesity would be appealing if safe, effective, and durable.The subsequent 5 subjects had a successfully completed procedure.The initial human clinical experience showed promising results for effective and safe GERD and obesity therapy.
Affiliation: Saint George University Teaching Hospital, Szekesfehervar, Hungary.Show MeSH
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Mentions: The excision device was introduced into the proximal stomach and the stomach was insufflated after a 6 mm endoscope was introduced through the device (Supplemental Data Figure S1; available online at http://SRI.sagepub.com/supplemental). After excision device positioning, a vacuum was applied and tissue was pulled into the excision device trough. A 4.2% hypertonic saline (HTS) and 1:100 000 adrenaline solution was injected and the vacuum was discontinued. The tissue escaped the capsule trough (Supplemental Data Figure S2) and the cushion was inspected for position, length, height, and width. If satisfactory the cushion was recaptured and again injected (Supplemental Data Figure S3). Excision was performed after a 60-second delay for adrenaline-mediated vasoconstriction. The vacuum was discontinued, the stomach was reinsufflated and the mucosa visualized in the bottom of the trough (Figure 3). A small elevating platform at the bottom of the trough was activated and the mucosal/submucosal strip was positioned (Supplemental Data Figure S4) so that it could be removed. A foreign body grasping forceps was introduced through the endoscope (Supplemental Data Figure S5) and the tissue was removed with the endoscope through the endoscope channel (Supplemental Data Figure S6). The tissue was pinned on a cork board for inspection and measurements. This same process was repeated 2 more times with the 3 excisions placed adjacent to each creating one confluent excision bed (Supplemental Data Figure S7). Blood clots were removed and then hypertonic saline was injected along the lesser curvature to form a restrictive fibrotic ring in obese patients only.
Affiliation: Saint George University Teaching Hospital, Szekesfehervar, Hungary.