title: Gastric wall healing after NOTES procedures: closure with endoscopic clips provides superior histological outcome compared with threaded tags closure.
abstract: BACKGROUND
  Closure of the transgastric access to the peritoneal cavity is a critical step in natural orifice transluminal endoscopic surgery (NOTES).
  
  
  OBJECTIVE
  To perform a direct comparison of the histological healing post clips and threaded tags (T-tags) closure after transgastric NOTES procedures.
  
  
  METHODS
  
  
  
  METHODS
  Twelve survival porcine experiments. After standardized endoscopic gastric wall puncture, balloon-dilation, and transgastric peritoneoscopy, closure of the gastric wall was performed with either clips or T-tags. Necropsy at 14 days was performed for histological evaluation of 2-mm interval transversal cross sections of the gastrotomy site.
  
  
  METHODS
  Histological healing of the gastric wall opening.
  
  
  RESULTS
  Endoscopic closure of the gastrotomy was successfully achieved in all 12 animals, followed by an uneventful 2-week clinical follow-up. Transmural healing was seen in 3 (75%) animals after clip closure compared with only 1 (12.5%) in the group with T-tag closure (P = .06). Gastric wall muscular bridging was observed in 4 (100%) animals with clip closure compared with only 1 (12.5%) in the group with T-tag closure (P = .01).
  
  
  CONCLUSIONS
  Animal model with short-term follow-up.
  
  
  CONCLUSIONS
  Endoscopic clip closure results in a layer-to-layer transmural healing of the gastric wall. In contrast, T-tag gastric wall plication impairs gastric layer bridging. These findings might guide the future design of new endoscopic devices and techniques for gastrotomy closure after NOTES procedures.
authors.affiliation: Division of Gastroenterology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Xavier
authors.initials: X
authors.lastname: Dray
authors.forename: Devi M
authors.initials: DM
authors.lastname: Krishnamurty
authors.forename: Gianfranko
authors.initials: G
authors.lastname: Donatelli
authors.forename: Kathleen L
authors.initials: KL
authors.lastname: Gabrielson
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Wroblewski
authors.forename: Eun J
authors.initials: EJ
authors.lastname: Shin
authors.forename: Samuel A
authors.initials: SA
authors.lastname: Giday
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Buscaglia
authors.forename: Laurie J
authors.initials: LJ
authors.lastname: Pipitone
authors.forename: Michael R
authors.initials: MR
authors.lastname: Marohn
authors.forename: Anthony N
authors.initials: AN
authors.lastname: Kalloo
authors.forename: Sergey V
authors.initials: SV
authors.lastname: Kantsevoy
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D016099:Endoscopy, Gastrointestinal; D005500:Follow-Up Studies; D005774:Gastrostomy / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D013270:Stomach / Q000473:pathology / Q000601:surgery*; D013536:Suture Techniques / Q000295:instrumentation*; D013537:Sutures; D013552:Swine; D014945:Wound Healing / Q000502:physiology*