title: Assessment of a simple, novel endoluminal method for gastrotomy closure in NOTES.
abstract: BACKGROUND
  A reliable method for gastrotomy closure in NOTES will be essential for NOTES to become viable clinically. However, methods using existing and widely available endoscopic accessories have been ineffective. The objective of this study was to evaluate the feasibility and safety of a new simple method for gastric closure (retracted clip-assisted loop closure) that uses existing endoscopic accessories with minor modifications.
  
  
  METHODS
  The retracted clip-assisted loop closure technique involves deploying 3-4 Resolution(®) clips (modified by attaching a 90-cm length of suture to the end of each clip) along the margin of the gastrotomy with one jaw on the serosal surface and the other jaw on the mucosal surface. The suture strings are threaded through an endoloop. Traction is then applied to the strings causing the gastric wall to tent. The endoloop is secured below the tip of the clips, completing a full-thickness gastrotomy closure. The main outcome measures were feasibility, efficacy, and safety of the new retracted clip-assisted loop closure technique for NOTES gastrotomy closure.
  
  
  RESULTS
  An air-tight seal was achieved in 100% (n = 9) of stomachs. The mean leak pressure was 116.3 (±19.4) mmHg.
  
  
  CONCLUSIONS
  The retracted clip-assisted loop closure technique can be used to perform NOTES gastrotomy closure by using existing endoscopic accessories with minor modifications.
authors.affiliation: Department of Gastroenterology, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Sang Soo
authors.initials: SS
authors.lastname: Lee
authors.forename: Brant K
authors.initials: BK
authors.lastname: Oelschlager
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Wright
authors.forename: Renato V
authors.initials: RV
authors.lastname: Soares
authors.forename: Huseyin
authors.initials: H
authors.lastname: Sinan
authors.forename: Martin I
authors.initials: MI
authors.lastname: Montenovo
authors.forename: Joo Ha
authors.initials: JH
authors.lastname: Hwang
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D005240:Feasibility Studies; D057605:Natural Orifice Endoscopic Surgery / Q000295:instrumentation / Q000379:methods*; D013270:Stomach / Q000601:surgery*; D013552:Swine