title: Endoscopic pyloroplasty with full-thickness transgastric and transduodenal myotomy with sutured closure.
abstract: BACKGROUND
  Pyloroplasty with myotomy and sutured closure is a surgical treatment for gastric outlet obstruction. It has not been previously performed at flexible endoscopy.
  
  
  OBJECTIVE
  To develop and test a method for performing a sutured pyloroplasty at flexible endoscopy.
  
  
  METHODS
  A Heinicke-Miculicz pyloroplasty was performed, forming a linear myotomy through the pylorus from the gastric side into the duodenal bulb. This was subsequently sutured transversely to increase the opening. The operation was performed in 3 nonsurvival studies in pigs. The safety and the efficacy was then studied in 7 animals followed for up to 4 weeks after the procedure.
  
  
  METHODS
  The studies were performed in experimental surgical units in Gothenburg, Sweden, and London, UK.
  
  
  METHODS
  A linear needle-knife incision was made through the pylorus; full-thickness sutures, by using a new T-tag and polypropylene thread suturing system through a flexible gastroscope, were placed to close the incision transversely. In 2 pigs, the prepyloric bulge was excised before the pyloroplasty.
  
  
  RESULTS
  Pyloroplasty was readily accomplished at flexible endoscopy in the 3 nonsurvival studies. Six of 7 pigs that survived in this study for periods of 7 to 28 days, recovered well, without complications. One pig (with bulge removal) developed gastric retention. The pyloric opening was increased; it was then easy to enter the duodenum at follow-up endoscopy.
  
  
  CONCLUSIONS
  This method has yet to be studied clinically.
  
  
  CONCLUSIONS
  Pyloroplasty with full-thickness pyloromyotomy and transverse closure of a linear myotomy was accomplished by using a simple flexible endosurgical technique to test a new flexible suturing system.
authors: Department of Surgery, Sahlgrenska University Hospital/Ostra, Gothenburg, Sweden.
authors: Per-Ola
authors: PO
authors: Park
authors: Maria
authors: M
authors: Bergström
authors: Keiichi
authors: K
authors: Ikeda
authors: Annette
authors: A
authors: Fritscher-Ravens
authors: Sandy
authors: S
authors: Mosse
authors: Michael
authors: M
authors: Kochman
authors: Paul
authors: P
authors: Swain
mesh_terms: D000818:Animals; D004386:Duodenum / Q000601:surgery; D020699:Gastroscopes; D005773:Gastroscopy / Q000009:adverse effects / Q000379:methods*; D009130:Muscle, Smooth / Q000601:surgery; D011708:Pylorus / Q000601:surgery*; D013536:Suture Techniques / Q000009:adverse effects; D013552:Swine