title: Eagle Claw II: A novel endosuture device that uses a curved needle for major arterial bleeding: a bench study.
abstract: 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.
authors.affiliation: Endoscopy Center, Prince of Wales Hospital, The Chinese University of Hong Kong.
authors.forename: Bing
authors.initials: B
authors.lastname: Hu
authors.forename: S C Sydney
authors.initials: SC
authors.lastname: Chung
authors.forename: Lawrence C L
authors.initials: LC
authors.lastname: Sun
authors.forename: Koichi
authors.initials: K
authors.lastname: Kawashima
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Peter B
authors.initials: PB
authors.lastname: Cotton
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Gostout
authors.forename: Robert H
authors.initials: RH
authors.lastname: Hawes
authors.forename: Anthony N
authors.initials: AN
authors.lastname: Kalloo
authors.forename: Sergey V
authors.initials: SV
authors.lastname: Kantsevoy
authors.forename: Pankaj J
authors.initials: PJ
authors.lastname: Pasricha
mesh_terms: 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