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

Research output: Contribution to journalArticlepeer-review

45 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 languageEnglish (US)
Pages (from-to)38-45
Number of pages8
JournalJournal of Gastrointestinal Surgery
Volume12
Issue number1
DOIs
StatePublished - Jan 2008

Keywords

  • Endoscopy
  • Minimally invasive surgery
  • NOTES
  • Stomach

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

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