title: Endoscopic full-thickness resection: circumferential cutting method.
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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgical Oncology and Technology, St Mary's Hospital, 41 Willow Road, London, UK.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Ikeda
authors.forename: C Alexander
authors.initials: CA
authors.lastname: Mosse
authors.forename: Per-Ola
authors.initials: PO
authors.lastname: Park
authors.forename: Annette
authors.initials: A
authors.lastname: Fritscher-Ravens
authors.forename: Maria
authors.initials: M
authors.lastname: Bergström
authors.forename: Tim
authors.initials: T
authors.lastname: Mills
authors.forename: Hisao
authors.initials: H
authors.lastname: Tajiri
authors.forename: C Paul
authors.initials: CP
authors.lastname: Swain
mesh_terms: D000818:Animals; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005240:Feasibility Studies; D016558:Hemostasis, Endoscopic; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D013536:Suture Techniques; D013552:Swine