Gastric wall healing after NOTES procedures: closure with endoscopic clips provides superior histological outcome compared with threaded tags closure - 24/08/11
Reprint requests: Sergey V. Kantsevoy, MD, PhD, The Institute for Digestive Health and Liver Disease at Mercy Medical Center, 301 St. Paul Place, 7th Floor, POB Suite 718, Baltimore, MD 21202-2165Résumé |
Background |
Closure of the transgastric access to the peritoneal cavity is a critical step in natural orifice transluminal endoscopic surgery (NOTES).
Objective |
To perform a direct comparison of the histological healing post clips and threaded tags (T-tags) closure after transgastric NOTES procedures.
Setting:
Design and Intervention |
Twelve survival porcine experiments. After standardized endoscopic gastric wall puncture, balloon-dilation, and transgastric peritoneoscopy, closure of the gastric wall was performed with either clips or T-tags. Necropsy at 14 days was performed for histological evaluation of 2-mm interval transversal cross sections of the gastrotomy site.
Main Outcome Measurements |
Histological healing of the gastric wall opening.
Results |
Endoscopic closure of the gastrotomy was successfully achieved in all 12 animals, followed by an uneventful 2-week clinical follow-up. Transmural healing was seen in 3 (75%) animals after clip closure compared with only 1 (12.5%) in the group with T-tag closure (P = .06). Gastric wall muscular bridging was observed in 4 (100%) animals with clip closure compared with only 1 (12.5%) in the group with T-tag closure (P = .01).
Limitations |
Animal model with short-term follow-up.
Conclusions |
Endoscopic clip closure results in a layer-to-layer transmural healing of the gastric wall. In contrast, T-tag gastric wall plication impairs gastric layer bridging. These findings might guide the future design of new endoscopic devices and techniques for gastrotomy closure after NOTES procedures.
Le texte complet de cet article est disponible en PDF.Abbreviations : NOTES, T-tags
Plan
| DISCLOSURE: The following authors disclosed financial relationships relevant to this publication: S.V. Kantsevoy: equity holder in Apollo Endosurgery Inc. A.N. Kalloo: equity holders in Apollo Endosurgery Inc. The other authors disclosed no financial relationships relevant to this publication. The threaded tags for use during this study were provided free of charge by Wilson-Cook Medical Inc, Winston-Salem, NC. The overtubes for this study were provided free of charge by Apollo Endosurgery Inc, Austin, TX. |
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| If you would like to chat with an author of this article, you may contact Dr. Kantsevoy at skan51@hotmail.com. |
Vol 72 - N° 2
P. 343-350 - août 2010 Retour au numéro
Article précédent
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