title: Mucosal excision and suturing for obesity and GERD.
abstract: BACKGROUND
  Suture and staple-based endoluminal devices for gastroesophageal reflux disease (GERD) and obesity have failed to demonstrate long-term efficacy.
  
  
  OBJECTIVE
  To demonstrate the feasibility of mucosal excision and full-thickness suture apposition of the excision beds to create sufficient scar tissue formation at the gastroesophageal junction for the intraluminal treatment of GERD or obesity.
  
  
  METHODS
  Survival animal experiments.
  
  
  METHODS
  Seven mongrel dogs. Interventions. Under general endotracheal anesthesia, a Barostat test was performed on 4 dogs. A mucosal excision device was introduced through the esophagus into the proximal stomach. Two to 4 mucosal excisions were performed on all dogs at or just below the gastroesophageal junction and the mucosal pieces were removed. After hemostasis, an intraluminal suturing instrument was introduced and either 2 or 4 sutures were placed through the excision beds to bring them into apposition. These were tied and the suture strands cut. All dogs were survived for 2 months. End-term endoscopies were performed, and a repeat Barostat procedure was performed on the animals undergoing an antireflux procedure. After euthanasia the stomachs were explanted, examined, photographed, and sectioned for histologic examination.
  
  
  RESULTS
  All dogs survived without complication. In the 4 GERD dogs, the Barostat studies demonstrated a significant decrease in gastroesophageal junction compliance. In the 3 dogs undergoing the obesity procedure, the gastric outlet apposition to a 6-mm endoscope was satisfactory with full insufflation and the desired scarring was seen on histologic examination.
  
  
  CONCLUSIONS
  It is possible to create adequate gastroesophageal junction scarring for the treatment of GERD and obesity. A clinical pilot study will be initiated.
authors: 1Creighton University School of Medicine, Omaha, NE, USA.
authors: András
authors: A
authors: Légner
authors: Kazuto
authors: K
authors: Tsuboi
authors: Rudolf
authors: R
authors: Stadlhuber
authors: Fumiaki
authors: F
authors: Yano
authors: Peter
authors: P
authors: Halvax
authors: Brandon
authors: B
authors: Hunt
authors: Wayne
authors: W
authors: Penka
authors: Charles J
authors: CJ
authors: Filipi
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D004285:Dogs; D004724:Endoscopy; D004943:Esophagogastric Junction / Q000503:physiopathology / Q000601:surgery*; D005753:Gastric Mucosa / Q000601:surgery*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D009765:Obesity / Q000601:surgery*; D013536:Suture Techniques / Q000295:instrumentation*
keywords: esophageal surgery; flexible endoscopy; gastric surgery