Endoscopic full-thickness biopsy of the gastric wall with defect closure by using an endoscopic suturing device: survival porcine study.
BACKGROUND
The pathogenesis of several common gastric motility diseases and functional GI disorders remains essentially unexplained. Gastric wall biopsies that include the muscularis propria to evaluate the enteric nervous system, interstitial cells of Cajal, and immune cells can provide important insights for our understanding of the etiology of these disorders.


OBJECTIVE
To determine the technical feasibility, reproducibility, and safety of performing a full-thickness gastric biopsy (FTGB) by using a submucosal endoscopy with mucosal flap (SEMF) technique; the technical feasibility, reproducibility, and safety of tissue closure by using an endoscopic suturing device; the ability to identify myenteric ganglia in resected specimens; and the long-term safety.


METHODS
Single center, preclinical survival study.


METHODS
Animal research laboratory, developmental endoscopy unit.


METHODS
Twelve domestic pigs.


METHODS
Animals underwent an SEMF procedure with gastric muscularis propria resection. The resultant offset mucosal entry site was closed by using an endoscopic suturing device. Animals were kept alive for 2 weeks.


METHODS
The technical feasibility, reproducibility, and safety of the procedure; the clinical course of the animals; the histological and immunochemical evaluation of the resected specimen to determine whether myenteric ganglia were present in the sample.


RESULTS
FTGB was performed by using the SEMF technique in all 12 animals. The offset mucosal entry site was successfully closed by using the suturing device in all animals. The mean resected tissue specimen size was 11 mm. Mean total procedure time was 61 minutes with 2 to 4 interrupted sutures placed per animal. Histology showed muscularis propria and serosa, confirming full-thickness resections in all animals. Myenteric ganglia were visualized in 11 of 12 animals. The clinical course was uneventful. Repeat endoscopy and necropsy at 2 weeks showed absence of ulceration at both the mucosal entry sites and overlying the more distal muscularis propria resection sites. There was complete healing of the serosa in all animals with minimal single-band adhesions in 5 of 12 animals. Retained sutures were present in 10 of 12 animals.


CONCLUSIONS
Animal experiment.


CONCLUSIONS
FTGB by using the SEMF technique and an endoscopic suturing device is technically feasible, reproducible, and safe. Larger tissue specimens will allow improved analysis of multiple cell types.
Developmental Endoscopy Unit, Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
Elizabeth
E
Rajan
Christopher J
CJ
Gostout
Eduardo
E
Aimore Bonin
Erica A
EA
Moran
Richard G
RG
Locke
Lawrence A
LA
Szarka
Nicholas J
NJ
Talley
Jodie L
JL
Deters
Charles A
CA
Miller
Mary A
MA
Knipschield
Matthew S
MS
Lurken
Gary J
GJ
Stoltz
Cheryl E
CE
Bernard
Madhusudan
M
Grover
Gianrico
G
Farrugia
D000818:Animals; D001706:Biopsy / Q000009:adverse effects / Q000379:methods; D005753:Gastric Mucosa / Q000601:surgery; D005767:Gastrointestinal Diseases / Q000175:diagnosis; D005773:Gastroscopy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D009197:Myenteric Plexus; D013270:Stomach / Q000294:innervation / Q000473:pathology*; D013524:Surgical Flaps; D013536:Suture Techniques / Q000295:instrumentation; D013552:Swine; D000267:Tissue Adhesions / Q000209:etiology