Gastric full-thickness suturing during EMR and for treatment of gastric-wall defects (with video).
BACKGROUND
The endoscopic full-thickness Plicator device was initially developed to provide an endoscopic treatment option for patients with GERD. Because the endoscopic full-thickness Plicator enables rapid and easy placement of transmural sutures, comparable with surgical sutures, we used the Plicator device for endoscopic treatment or prevention of GI-wall defects.


OBJECTIVE
To describe the outcomes and complications of endoscopic full-thickness suturing during EMR and for the treatment of gastric-wall defects.


METHODS
A report of 4 cases treated with the endoscopic full-thickness suturing between June 2006 and April 2007.


METHODS
A large tertiary-referral center.


METHODS
Four subjects received endoscopic full-thickness suturing. The subjects were women, with a mean age of 67 years.


METHODS
Of the 4 subjects, 3 received endoscopic full-thickness suturing during or after an EMR. One subject received endoscopic full-thickness suturing for treatment of a fistula.


METHODS
Primary outcome measurements were clinical procedural success and procedure-related adverse events.


RESULTS
The mean time for endoscopic full-thickness suturing was 15 minutes. In all cases, GI-wall patency was restored or ensured, and no procedure-related complications occurred. All subjects responded well to endoscopic full-thickness suturing.


CONCLUSIONS
The resection of one GI stromal tumor was incomplete. Because of the Plicator's 60F distal-end diameter, endoscopic full-thickness suturing could only be performed with the patient under midazolam and propofol sedation. The durable Plicator suture might compromise the endoscopic follow-up after EMR.


CONCLUSIONS
The endoscopic full-thickness Plicator permits rapid and easy placement of transmural sutures and seems to be a safe and effective alternative to surgical intervention to restore GI-wall defects or to ensure GI-wall patency during EMR procedures.
von Renteln
Daniel
D
Medizinische Klinik I, Klinikum Ludwigsburg, Ludwigsburg, Germany.
Schmidt
Arthur
A
Riecken
Bettina
B
Caca
Karel
K
D000236:Adenoma / Q000175:diagnosis / Q000601:surgery*; D000368:Aged; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D019160:Endosonography; D005260:Female; D005500:Follow-Up Studies; D005747:Gastric Fistula / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D013270:Stomach / Q000601:surgery*; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000601:surgery*; D013536:Suture Techniques; D014741:Video Recording