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DOI: 10.1055/a-1451-3854
Applying basic principles of surgery may pave the way for more effective endoscopic bariatric techniques
Abstract
Background and study aims In the last decade, gastroenterologists have been attempting to use endoscopy to reproduce the great success of traditional surgical suture techniques. Despite recent advances, we still lack a reliable method that results in a permanent suture with minimal incidence of suture failure. This was an experimental study in pigs with an innovative technique that applied basic surgical concepts to endoscopy to evaluate the effectiveness of a novel suture technique.
Methods The procedures were performed on six live pigs under general anesthesia. Endoscopic mucosal resection (EMR) first was performed in the stomach, exposing the submucosal or muscularis propria layers. A novel device, a transparent chamber cap (DASE), was developed to aspirate the gastric wall, allowing the sutures to reach deep layers. The aspiration was performed with a standard gastroscope to which the novel cap was distally attached. Three sutures aligned were defined as a plication. Each pig received two or three plications and was placed on a liquid diet for 14 days after the procedure. The pigs were sacrificed at 4 and 8 weeks and the sutures were reviewed.
Results The technique was feasible in all animals. Of 16 plications, only one failed. One perforation occurred after EMR. There were no other complications or adverse events. Permanent fusion of the gastric wall was confirmed by histology in all cases.
Conclusions This study showed that basic principles of surgery can be applied endoscopically to ensure a permanent suture with reduced chances of failure. These findings can help to pave the way for more effective bariatric endoscopic techniques.
Publication History
Received: 20 August 2020
Accepted: 15 February 2021
Article published online:
17 June 2021
© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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References
- 1 Hyuk SC. Development and application of endoscopic suturing devices. In: IDEN2016 – Round table in UGS-II: Recent Issues in Upper GI Endoscopy, 2016. Seoul, Korea: 2016 Available from (cited 2019 May 13): https://pdfs.semanticscholar.org/625f/ba1f214b28a9d57a470a57a265518acd73a1.pdf
- 2 Hashiba K, Averbach M, Brasil HA. et al. Endoscopic suturing procedure: what it can do and how it should be made. Gastrointest Endosc 2013; 77: AB461-AB462
- 3 Hardy KJ. A view of the development of intestinal suture Part II. Principles and Techniques. Aust NZJ Surg 1990; 60: 377-384
- 4 Lembert A. Mémoire sur L'énteroraphie: avec la description d'un procédé nouveau pour pratiquer cette operation chirurgicale. Rep Gén Anat Phys Path 1826; 2: 100-107
- 5 Gross SD. An Experimental and Critical Inquiry into the Nature and Treatment of the Wounds of the Intestines. Louisville: Prentice and Weissinger; 1841: 5
- 6 Halsted WS. Intestinal anastomosis. Bull Johns Hopk Hosp 1891; 2: 1
- 7 Witte MB, Barbul A. General Principles of Wound Healing. Surg Clin North Am 1997; 77: 509-528
- 8 Bevilacqua R, Chapchap P, Almeida CG. Cicatrização. In: Allgower M, Bevilacqua RG. Manual de Cirurgia. 4ª ed. São Paulo: EPI-Springer; 1981: 1-20
- 9 Alqahtani a, Al-Darwish A, Mahmoud AE. et al. Short-term outcomes of endoscopic sleeve: gastroplasty in 1000 consecutive patients. Gastrointest Endosc 2019; 89: 1132-1138