title: Gastric full-thickness suturing during EMR and for treatment of gastric-wall defects (with video).
abstract: 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.
authors.affiliation: Medizinische Klinik I, Klinikum Ludwigsburg, Ludwigsburg, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: von Renteln
authors.forename: Arthur
authors.initials: A
authors.lastname: Schmidt
authors.forename: Bettina
authors.initials: B
authors.lastname: Riecken
authors.forename: Karel
authors.initials: K
authors.lastname: Caca
mesh_terms: 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