title: A through-the-scope device for suturing and tissue approximation under EUS control.
abstract: BACKGROUND
  The ability to place sutures under EUS control might allow development of a new type of transluminal endosurgery. The aim of this study was to develop endoscopic methods for suturing to variable predetermined depths in the wall of the GI tract and to allow fixation of adjacent hollow organs under EUS control.
  
  
  METHODS
  A suturing device was constructed for suturing under EUS control to any desired depth. Sutures can also be placed into hollow or solid organs within 5 cm of the endoscope tip. The device allows multiple sutures to be placed without withdrawing the endoscope. Stitching, knot-tying, and thread-cutting are achieved through a 2.8-mm accessory channel.
  
  
  RESULTS
  Multiple (>100) sutures were placed in predetermined gut wall layers in pigs. Sutures were placed in the gallbladder (n = 7) and small intestine (n = 8) to fix the gallbladder/small intestine to the stomach and allow traction for the insertion of stents and other devices through the 2 lumens.
  
  
  CONCLUSIONS
  A new method for stitching under flexible EUS control is described. This technology was used to place sutures at precise depths in the GI tract. It allowed fixation of other organs to the accessible GI tract for various purposes including delivery of stents and devices for creating anastomoses.
authors.affiliation: Academic Department of Gastroenterology, The Royal London Hospital, Whitechapel, England.
authors.forename: Annette
authors.initials: A
authors.lastname: Fritscher-Ravens
authors.forename: C Alexander
authors.initials: CA
authors.lastname: Mosse
authors.forename: Timothy N
authors.initials: TN
authors.lastname: Mills
authors.forename: Dip
authors.initials: D
authors.lastname: Mukherjee
authors.forename: Per-Ola
authors.initials: PO
authors.lastname: Park
authors.forename: Paul
authors.initials: P
authors.lastname: Swain
mesh_terms: D000818:Animals; D019160:Endosonography / Q000295:instrumentation* / Q000379:methods; D005704:Gallbladder / Q000000981:diagnostic imaging; D007421:Intestine, Small / Q000000981:diagnostic imaging; D013270:Stomach / Q000000981:diagnostic imaging; D013536:Suture Techniques; D013552:Swine