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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 illustrating repair of the post-EFTR defects. The defects were closed with serosal apposition while inverting the serosal edges into the luminal side.
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Fig4: Schematic illustrating repair of the post-EFTR defects. The defects were closed with serosal apposition while inverting the serosal edges into the luminal side.

Mentions: Closure of the defects was performed with the OverStitch™ system. Although this system is designed to be attached on the tip of the Olympus GIF 2 T-160, the Olympus 160 series scope is not available in Japan. Therefore, the device was securely taped on the tip of a GIF 2 T-240. The suture used in this study was non-absorbable and made of polypropylene. Absorbable polydioxanone suture is now available for the OverStitch™ system and might be more appropriate for the applications tested in this study, but it was not available when the study was conducted. All post-ESD and EFTR defects were completely approximated with interrupted sutures that were placed every 5–10 mm immediately after tissue removal. The post-ESD ulcers were closed with mucosal tissue apposition, and the post-EFTR defects were closed with serosal apposition while inverting the serosal edges into the luminal side. For post-EFTR closures, full-thickness penetration of the suturing needle was endoscopically confirmed at every suture placement to ensure serosal apposition (Figure 4). To evacuate excessive intra-abdominal air, an 18-gauge needle (Nipro Co., Osaka, Japan) was percutaneously placed in the anterior abdominal wall.Figure 4


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 illustrating repair of the post-EFTR defects. The defects were closed with serosal apposition while inverting the serosal edges into the luminal side.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig4: Schematic illustrating repair of the post-EFTR defects. The defects were closed with serosal apposition while inverting the serosal edges into the luminal side.
Mentions: Closure of the defects was performed with the OverStitch™ system. Although this system is designed to be attached on the tip of the Olympus GIF 2 T-160, the Olympus 160 series scope is not available in Japan. Therefore, the device was securely taped on the tip of a GIF 2 T-240. The suture used in this study was non-absorbable and made of polypropylene. Absorbable polydioxanone suture is now available for the OverStitch™ system and might be more appropriate for the applications tested in this study, but it was not available when the study was conducted. All post-ESD and EFTR defects were completely approximated with interrupted sutures that were placed every 5–10 mm immediately after tissue removal. The post-ESD ulcers were closed with mucosal tissue apposition, and the post-EFTR defects were closed with serosal apposition while inverting the serosal edges into the luminal side. For post-EFTR closures, full-thickness penetration of the suturing needle was endoscopically confirmed at every suture placement to ensure serosal apposition (Figure 4). To evacuate excessive intra-abdominal air, an 18-gauge needle (Nipro Co., Osaka, Japan) was percutaneously placed in the anterior abdominal wall.Figure 4

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