Endoscopy 2012; 44 - A02
DOI: 10.1055/s-0032-1329275

Comparison of endoscopic suturing techniques for closure of the transgastric entrance site for NOTES procedure

JR Armengol Miro 1, M Abu-Suboh Abadia 1, J Dot Bach 1, M Masachs Peracaula 1, J Armengol Bertroli 1, A Benages Curell 1, JC Salord 1, SV Kantsevoy 1
  • 1Adress available at: European Society of Gastrointestinal Endoscopy (ESGE), HG Editorial & Management Services, Mauerkircher Str. 29, 81679 Munich, Germany

Background: Endoscopic closure of the transgastric wall incision created to enter the peritoneal cavity remains problematic. Several techniques (closure with endoscopic clips, T-bars, stapling devices, etc.) have not achieved quality of closure comparable to surgical suturing.

Aim: To compare clinical and histological results of continuous suture line and interrupted stitches created by novel endoscopic suturing device (Overstitch®, Apollo Endosurgery, Inc, Austin, YX) in a randomized, prospective, controlled animal trial.

Methods: Standard transgastric access to the peritoneal cavity was achieved utilizing gastric wall puncture with subsequent dilation with 20-mm CRE balloon (Boston Scientific, Natick, MA). After brief peritoneoscopy the endoscope was withdrawn into the stomach and all animals were randomly assign to gastric incision closure with either continuous (4 – 6 sequential punctures of each site of the gastric wall incision with subsequent tightening and cinching the suture line) or interrupted line of stitches (one puncture on each site of the incision with subsequent cinching). After completion of the suturing the stomach was insufflated with carbon dioxide and air-leak test was performed to prove air-tightness of the closure. All animals were survived for 14 days and then sacrificed for histological examination.

Results: 16 survival animal experiments (8 in each group) were successfully completed. Suturing of the gastric wall incision was easily achieved and airtight in all animals. The mean time to complete continuous line of sutures was 7,43±2,59 minutes, the mean time to complete the closure with interrupted stitches was 10,49±3,8 minutes. There were no post-procedural complications in any animals.

Postmortem examination revealed no signs of peritonitis or other intraperitoneal complications in both groups. Histological examination in all animals demonstrated complete transmural healing with good opposition of gastric wall layers.

Conclusion: Overstitch® endoscopic suturing device is easy to use, reliable and operator-friendly instrument. Closure of the gastric wall incision with continuous suture line was faster, but the clinical and histological results were equally successful in both groups