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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

A post-ESD ulcer at the end of the survival period (1 week after ESD). The sutures used to repair the post-ESD ulcers had loosened and the ulcer floors were exposed in all cases.
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Fig7: A post-ESD ulcer at the end of the survival period (1 week after ESD). The sutures used to repair the post-ESD ulcers had loosened and the ulcer floors were exposed in all cases.

Mentions: In this study, all pigs survived the 1-week survival period. Successful primary closure was achieved in 85.7% (12/14) of the lesions in the post-ESD group (Figure 5) and 100% (3/3) in the post-EFTR group (p = 0.67; Figure 6). Except for two post-ESD ulcers in the first animal to undergo the procedure, primary defect closure was achieved during all attempts. In the cases with successful primary closure (n = 12 for the post-ESD group and n = 3 for the post-EFTR group), the mean maximum diameter of sampled ESD specimens was 45.0 ± 9.3 mm (range, 35–65 mm); the mean maximum diameter of sampled EFTR specimens was 31.6 ± 2.4 mm (range, 30–35 mm; p = 0.015). The median procedure time was 15.5 ± 10.0 minutes (range, 7–40 minutes) in the post-ESD group and 74.0 ± 22.6 minutes (range, 35–89 minutes) in the post-EFTR group (p = 0.02), while the median number of sutures required to close the defects was 2.0 ± 0.5 (range, 2–3 sutures) in the post-ESD group and 4 sutures in the post-EFTR group (p = 0.005). In the post-ESD animal with unsuccessful primary ulcer repair, tarry stool was observed for 4 days. The successful secondary closure rate was 0% (0/12) in the post-ESD group (Figure 7) and 100% (3/3) in the post-EFTR group (p = 0.002; Table 1, Figure 8). In the post-ESD group, follow-up endoscopy demonstrated that the majority of the sutures barely hung on to one edge of the ulcers, but that the sutures were intact, and that the ulcers were wide open with irregular polygonal contours. The control post-ESD ulcer remained open with a sharp round contour. Meanwhile, it was histologically confirmed that the reduction in defect size established by serosal approximation after EFTR was sustained for 1 week (Figure 9). At necropsy, no surrounding organ injury due to the sutures was observed in any of the pigs. However, minor abscesses and adhesions were observed in 2 of the 3 animals (66%) in the post-EFTR group (Table 2).Figure 5


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)

A post-ESD ulcer at the end of the survival period (1 week after ESD). The sutures used to repair the post-ESD ulcers had loosened and the ulcer floors were exposed in all cases.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig7: A post-ESD ulcer at the end of the survival period (1 week after ESD). The sutures used to repair the post-ESD ulcers had loosened and the ulcer floors were exposed in all cases.
Mentions: In this study, all pigs survived the 1-week survival period. Successful primary closure was achieved in 85.7% (12/14) of the lesions in the post-ESD group (Figure 5) and 100% (3/3) in the post-EFTR group (p = 0.67; Figure 6). Except for two post-ESD ulcers in the first animal to undergo the procedure, primary defect closure was achieved during all attempts. In the cases with successful primary closure (n = 12 for the post-ESD group and n = 3 for the post-EFTR group), the mean maximum diameter of sampled ESD specimens was 45.0 ± 9.3 mm (range, 35–65 mm); the mean maximum diameter of sampled EFTR specimens was 31.6 ± 2.4 mm (range, 30–35 mm; p = 0.015). The median procedure time was 15.5 ± 10.0 minutes (range, 7–40 minutes) in the post-ESD group and 74.0 ± 22.6 minutes (range, 35–89 minutes) in the post-EFTR group (p = 0.02), while the median number of sutures required to close the defects was 2.0 ± 0.5 (range, 2–3 sutures) in the post-ESD group and 4 sutures in the post-EFTR group (p = 0.005). In the post-ESD animal with unsuccessful primary ulcer repair, tarry stool was observed for 4 days. The successful secondary closure rate was 0% (0/12) in the post-ESD group (Figure 7) and 100% (3/3) in the post-EFTR group (p = 0.002; Table 1, Figure 8). In the post-ESD group, follow-up endoscopy demonstrated that the majority of the sutures barely hung on to one edge of the ulcers, but that the sutures were intact, and that the ulcers were wide open with irregular polygonal contours. The control post-ESD ulcer remained open with a sharp round contour. Meanwhile, it was histologically confirmed that the reduction in defect size established by serosal approximation after EFTR was sustained for 1 week (Figure 9). At necropsy, no surrounding organ injury due to the sutures was observed in any of the pigs. However, minor abscesses and adhesions were observed in 2 of the 3 animals (66%) in the post-EFTR group (Table 2).Figure 5

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