Endoscopic full-thickness resection: circumferential cutting method.
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.
Ikeda
Keiichi
K
Department of Surgical Oncology and Technology, St Mary's Hospital, 41 Willow Road, London, UK.
Mosse
C Alexander
CA
Park
Per-Ola
PO
Fritscher-Ravens
Annette
A
Bergström
Maria
M
Mills
Tim
T
Tajiri
Hisao
H
Swain
C Paul
CP
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