Eagle Claw II: A novel endosuture device that uses a curved needle for major arterial bleeding: a bench study.
BACKGROUND
Control of bleeding from major arteries in the upper-GI tract remains difficult with currently available endoscopic devices. We designed an endosuture device that uses a curved needle and extracorporeal knotting, and assessed the device in stopping arterial bleeding in a bench model.


METHODS
Harvested porcine splenic arteries (2-mm diameter) were tunneled submucosally in pig stomach with the open end protruding into an artificially created mucosal defect. The outer end of the vessel was connected to a pulsatile pump, and red ink was infused at a pressure of about 100 mm Hg. The stomach was installed on an Erlangen endo-training model. The suturing device (Eagle Claw II), mounted outside an endoscope, has an eyed, curved needle that carries a 3-0 nylon thread. After puncture, the thread was retrieved by using a hook. Three-throw square knots were tied at the thread extracorporeally and were pushed into place by using a knotting cap. The criteria of successful plication was defined as hemostasis after knotting, no leakage at pressures of >200 mm Hg, and the vessel was completely encircled by the suture.


RESULTS
A total of 25 sutures were made with the mean time of 9.38 minutes (standard deviation 1.51). Control of the bleeding was obtained with 17 sutures (68%). The causes for failure were the following: a suture was too shallow (4), a loose knot (2), incorrect suture position (1), and stomach-wall edema (1).


CONCLUSIONS
Control of bleeding from large arteries by using endoscopic suturing is possible. Continued refinements of the device are required.
Hu
Bing
B
Endoscopy Center, Prince of Wales Hospital, The Chinese University of Hong Kong.
Chung
S C Sydney
SC
Sun
Lawrence C L
LC
Kawashima
Koichi
K
Yamamoto
Tetsuya
T
Cotton
Peter B
PB
Gostout
Christopher J
CJ
Hawes
Robert H
RH
Kalloo
Anthony N
AN
Kantsevoy
Sergey V
SV
Pasricha
Pankaj J
PJ
D000818:Animals; D006471:Gastrointestinal Hemorrhage / Q000601:surgery*; D005773:Gastroscopy; D006489:Hemostatic Techniques / Q000295:instrumentation*; D066298:In Vitro Techniques; D013157:Splenic Artery / Q000601:surgery; D013552:Swine