Complete Endoscopic Closure of Gastric Defects Using a Full-Thickness Tissue Plicating Device

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.

Endoscopic full-thickness plication for the treatment of gastroesophageal reflux disease using multiple Plicator implants: 12-month multicenter study results

“…In addition to GERD treatment, the Plicator device can be used for endoluminal suturing of gastrointestinal (GI) wall perforations or for natural orifice transluminal endoscopic surgery (NOTES) gastrotomy closure [50][51][52][53][54]. A recent study evaluating the Plicator with modified pledgets and resorbable sutures demonstrated successful and reliable NOTES gastrotomy closure in an animal survival trial [55].…”

“…Because the device enables rapid and easy placement of leakproof transmural sutures with serosal apposition, the device seems suitable for closure of GI wall defects or NOTES gastrotomy. For reliable NOTES gastrotomy or perforation closure, a transmural suturing device enabling serosal apposition is of fundamental importance to achieve reliable closure strength [51][52][53][54][55][56][57].…”

Peritoneal inflammatory response of natural orifice translumenal endoscopic surgery (NOTES) versus laparoscopy with carbon dioxide and air pneumoperitoneum

“…The NOTES gastrotomy finally was closed with an endoscopic tissue plicating device (NDO Plicator; NDO Surgical, Mansfield, MA, USA) using a technique developed and reported by our group [9,10]. Briefly, two or three pledgeted suture implants were deployed by the NDO Plicator to invert the tissue and close the gastrotomy with full-thickness bites.…”

NOTES for the management of an intra-abdominal abscess: transcolonic peritonoscopy and abscess drainage in a canine model

“…5 In fact, members of SAGES and ASGE recommended that access site closure reach 100% reliability before NOTES is approved for clinical trials in the United States. 5,15 Balloon-dilated gastrotomies in a porcine model have been observed to close spontaneously without specific efforts directed at closure. 16 However, incomplete access site closure in pigs has also been reported and resulted in complications as severe as frank peritonitis.…”