Complete endoscopic closure of gastric defects using a full-thickness tissue plicating device

Michael F. McGee; Jeffrey M. Marks; Judy Jin; Christina Williams; Amitabh Chak; Steve J. Schomisch; Jamie Andrews; Shoichi Okada; Jeffrey L. Ponsky

doi:10.1007/s11605-007-0371-0

Complete endoscopic closure of gastric defects using a full-thickness tissue plicating device

Michael F. McGee, Jeffrey M. Marks^*, Judy Jin, Christina Williams, Amitabh Chak, Steve J. Schomisch, Jamie Andrews, Shoichi Okada, Jeffrey L. Ponsky

^*Corresponding author for this work

Surgery, Gastrointestinal/Endocrinology Division

Research output: Contribution to journal › Article › peer-review

46 Scopus citations

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.

Original language	English (US)
Pages (from-to)	38-45
Number of pages	8
Journal	Journal of Gastrointestinal Surgery
Volume	12
Issue number	1
DOIs	https://doi.org/10.1007/s11605-007-0371-0
State	Published - Jan 2008

Funding

Disclosure: Research funding necessary to conduct the study was provided by NDO Surgical, in the form of a grant totaling $26,407.86. Two tissue plicating devices were provided for experimental use, as well as an unlimited supply of implants. None of the authors have any financial relationship with NDO Surgical. M.F.McGee.J.M.Marks(*).J.Jin.C.Williams. S. J. Schomisch.J. Andrews.S. Okada.J. L. Ponsky Department of Surgery, University Hospitals Case Medical Center, Case Western Reserve University, 11100 Euclid Avenue, 7th Floor Lakeside Bldg, Cleveland, OH 44106, USA e-mail: [email protected]

Keywords

Endoscopy
Minimally invasive surgery
NOTES
Stomach

ASJC Scopus subject areas

Gastroenterology
Surgery

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10.1007/s11605-007-0371-0

Cite this

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title = "Complete endoscopic closure of gastric defects using a full-thickness tissue plicating device",

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.",

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note = "Funding Information: Disclosure: Research funding necessary to conduct the study was provided by NDO Surgical, in the form of a grant totaling $26,407.86. Two tissue plicating devices were provided for experimental use, as well as an unlimited supply of implants. None of the authors have any financial relationship with NDO Surgical. M.F.McGee.J.M.Marks(*).J.Jin.C.Williams. S. J. Schomisch.J. Andrews.S. Okada.J. L. Ponsky Department of Surgery, University Hospitals Case Medical Center, Case Western Reserve University, 11100 Euclid Avenue, 7th Floor Lakeside Bldg, Cleveland, OH 44106, USA e-mail: [email protected]",

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AU - Okada, Shoichi

AU - Ponsky, Jeffrey L.

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Complete endoscopic closure of gastric defects using a full-thickness tissue plicating device

Abstract

Funding

Keywords

ASJC Scopus subject areas

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