TY - JOUR
T1 - Gastric wall healing after NOTES procedures
T2 - Closure with endoscopic clips provides superior histological outcome compared with threaded tags closure
AU - Dray, Xavier
AU - Krishnamurty, Devi M.
AU - Donatelli, Gianfranko
AU - Gabrielson, Kathleen L.
AU - Wroblewski, Ronald J.
AU - Shin, Eun J.
AU - Giday, Samuel A.
AU - Buscaglia, Jonathan M.
AU - Pipitone, Laurie J.
AU - Marohn, Michael R.
AU - Kalloo, Anthony N.
AU - Kantsevoy, Sergey V.
N1 - Funding Information:
Xavier Dray thanks the French National Society for Gastroenterology (Société Nationale Française de Gastroentérologie, Robert Tournut Scholarship, 2006) and the American Gastroenterological Association Foundation for Digestive Health and Nutrition (Jon I. Isenberg International Scholar Award, 2007) for supporting his training and research in NOTES.
Copyright:
Copyright 2012 Elsevier B.V., All rights reserved.
PY - 2010/8
Y1 - 2010/8
N2 - 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.
AB - 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.
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U2 - 10.1016/j.gie.2010.02.023
DO - 10.1016/j.gie.2010.02.023
M3 - Article
C2 - 20674622
AN - SCOPUS:77955668541
SN - 0016-5107
VL - 72
SP - 343
EP - 350
JO - Gastrointestinal endoscopy
JF - Gastrointestinal endoscopy
IS - 2
ER -