Endoscopic full-thickness resection: circumferential cutting method.

Keiichi Ikeda; C Alexander Mosse; Per-Ola Park; Annette Fritscher-Ravens; Maria Bergström; Tim Mills; Hisao Tajiri; C Paul Swain

doi:10.1016/j.gie.2005.12.039

PubMed · 16813808

Endoscopic full-thickness resection: circumferential cutting method.

Keiichi Ikeda·C Alexander Mosse·Per-Ola Park·Annette Fritscher-Ravens·Maria Bergström·Tim Mills·Hisao Tajiri·C Paul Swain

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Abstract

BACKGROUND: Endoscopic full-thickness resection (EFTR) at flexible endoscopy might allow less-invasive removal of more deeply penetrating cancers that have not spread to the serosal surface and more complete histologic examination of the excised tissue. OBJECTIVE: A method for closure of full-thickness defects in the stomach wall would be valuable for other endosurgical applications. SETTING: A method that uses an end cap and band-ligation without prior injection of saline solution to perform EFTR gave good results and was safe in pig studies. There is a size limitation of cancers that can be resected en bloc when using this method. The depth of resection was also variable. DESIGN AND INTERVENTIONS: EFTR was achieved by circumferential cutting with a sphincterotome and a snare. A prototype bidirectional cutter was tested. Sutured closure was accomplished by using a sheathed needle, a metal tag, and a thread at the tip, passed through a 2.8-mm accessory channel. Knot-tying devices secured the sutured defect. MAIN OUTCOME MEASUREMENTS: EFTR was studied in non-survival (n = 4) and survival (n = 8) experiments in pigs. RESULTS: Full-thickness specimens were resected from the gastric wall (100%, 12/12), and the defects were closed by using sewing and knot-tying devices (100%, 12/12). LIMITATIONS: A healing ulcer at the suturing site was evident at follow-up endoscopy in the survival experiments. Bleeding, which was stopped by suturing, occurred in 1 pig (8.3%, 1/12). All pigs survived these experiments without complications (100%, 8/8). CONCLUSIONS: Circumferential EFTR was feasible and appeared safe in survival experiments. This method might allow larger and deeper resection of tumors in the gastric wall.

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Animals Endoscopy, Gastrointestinal Feasibility Studies Hemostasis, Endoscopic Stomach Neoplasms Suture Techniques Swine Journal Article Research Support, Non-U.S. Gov't

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Keiichi Ikeda, C Alexander Mosse, Per-Ola Park, Annette Fritscher-Ravens, Maria Bergström, Tim Mills, Hisao Tajiri, C Paul Swain. 2006. Endoscopic full-thickness resection: circumferential cutting method.. https://doi.org/10.1016/j.gie.2005.12.039

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