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Closure of iatrogenic large mucosal and full-thickness defects of the stomach with endoscopic interrupted sutures in in vivo porcine models: are they durable enough?

Kobayashi M, Sumiyama K, Ban Y, Dobashi A, Ohya TR, Aizawa D, Hirooka S, Nakajima K, Tajiri H - BMC Gastroenterol (2015)

Bottom Line: Meanwhile, all of the post-EFTR defect closures were sustained for 1 week.Primary closure of post-therapeutic defects can be accomplished using the device.Inverted serosal apposition provides a more durable and reliable repair than everted mucosal apposition.

View Article: PubMed Central - PubMed

Affiliation: Division of Gastroenterology & Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan. k-masa@outlook.com.

ABSTRACT

Background: In this study, we evaluated the technical feasibility of mucosal approximation of large ulcers via an endoscopic suturing system after endoscopic submucosal dissection (ESD), assessed the durability of these sutures, and compared this technique with serosal apposition of full-thickness gastric wall defects using the same device.

Methods: Post-ESD ulcers were closed with mucosal apposition in 7 pigs, and endoscopic full-thickness resection (EFTR) defects were closed with serosal apposition in 3 pigs. Pigs recovered for 1 week; they were then euthanized and necropsies were performed.

Results: Primary defect closure was achieved in 85.7% of the post-ESD closures and in 100% of the post-EFTR closures (p = 0.67). All pigs survived for 1 week. At necropsy, sutures had loosened in the post-ESD animals, although only minor deformity of the ulcer edges was observed in all repaired post-ESD ulcers. Meanwhile, all of the post-EFTR defect closures were sustained for 1 week.

Conclusions: Primary closure of post-therapeutic defects can be accomplished using the device. Inverted serosal apposition provides a more durable and reliable repair than everted mucosal apposition.

No MeSH data available.


Related in: MedlinePlus

Schematic presentation of EFTR. T-bar style tissue anchors lifted the anterior gastric wall; a full-thickness incision was made in the tissue inside of the placed tissue anchors.
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Fig2: Schematic presentation of EFTR. T-bar style tissue anchors lifted the anterior gastric wall; a full-thickness incision was made in the tissue inside of the placed tissue anchors.

Mentions: EFTR was also performed with a two-channel therapeutic gastroscope via an overtube. First, digital palpation was used to identify safe sites for needle puncture (as with percutaneous endoscopic gastrostomy placement); the anterior gastric wall was then fixed to the abdominal wall at four points with T-bar style tissue anchors (Lesion lifting device; Sumitomo Bakelite Co., Ltd., Tokyo, Japan). Each tissue anchor consisted of a stainless steel rod and a wire preloaded within a 12-gauge needle and a flexible plastic outer sheath. The anterior abdominal and gastric walls were simultaneously punctured by the needle in a single stroke, and the rod was deployed into the gastric lumen. While lifting the anterior gastric wall with the anchors, an area greater than 30 mm in diameter was circumferentially incised full-thickness in the tented gastric wall inside of the four tissue anchors. Finally, the specimen was removed per os (Figures 2 and 3).Figure 2


Closure of iatrogenic large mucosal and full-thickness defects of the stomach with endoscopic interrupted sutures in in vivo porcine models: are they durable enough?

Kobayashi M, Sumiyama K, Ban Y, Dobashi A, Ohya TR, Aizawa D, Hirooka S, Nakajima K, Tajiri H - BMC Gastroenterol (2015)

Schematic presentation of EFTR. T-bar style tissue anchors lifted the anterior gastric wall; a full-thickness incision was made in the tissue inside of the placed tissue anchors.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4308917&req=5

Fig2: Schematic presentation of EFTR. T-bar style tissue anchors lifted the anterior gastric wall; a full-thickness incision was made in the tissue inside of the placed tissue anchors.
Mentions: EFTR was also performed with a two-channel therapeutic gastroscope via an overtube. First, digital palpation was used to identify safe sites for needle puncture (as with percutaneous endoscopic gastrostomy placement); the anterior gastric wall was then fixed to the abdominal wall at four points with T-bar style tissue anchors (Lesion lifting device; Sumitomo Bakelite Co., Ltd., Tokyo, Japan). Each tissue anchor consisted of a stainless steel rod and a wire preloaded within a 12-gauge needle and a flexible plastic outer sheath. The anterior abdominal and gastric walls were simultaneously punctured by the needle in a single stroke, and the rod was deployed into the gastric lumen. While lifting the anterior gastric wall with the anchors, an area greater than 30 mm in diameter was circumferentially incised full-thickness in the tented gastric wall inside of the four tissue anchors. Finally, the specimen was removed per os (Figures 2 and 3).Figure 2

Bottom Line: Meanwhile, all of the post-EFTR defect closures were sustained for 1 week.Primary closure of post-therapeutic defects can be accomplished using the device.Inverted serosal apposition provides a more durable and reliable repair than everted mucosal apposition.

View Article: PubMed Central - PubMed

Affiliation: Division of Gastroenterology & Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan. k-masa@outlook.com.

ABSTRACT

Background: In this study, we evaluated the technical feasibility of mucosal approximation of large ulcers via an endoscopic suturing system after endoscopic submucosal dissection (ESD), assessed the durability of these sutures, and compared this technique with serosal apposition of full-thickness gastric wall defects using the same device.

Methods: Post-ESD ulcers were closed with mucosal apposition in 7 pigs, and endoscopic full-thickness resection (EFTR) defects were closed with serosal apposition in 3 pigs. Pigs recovered for 1 week; they were then euthanized and necropsies were performed.

Results: Primary defect closure was achieved in 85.7% of the post-ESD closures and in 100% of the post-EFTR closures (p = 0.67). All pigs survived for 1 week. At necropsy, sutures had loosened in the post-ESD animals, although only minor deformity of the ulcer edges was observed in all repaired post-ESD ulcers. Meanwhile, all of the post-EFTR defect closures were sustained for 1 week.

Conclusions: Primary closure of post-therapeutic defects can be accomplished using the device. Inverted serosal apposition provides a more durable and reliable repair than everted mucosal apposition.

No MeSH data available.


Related in: MedlinePlus