title: In vivo assessment of a biological occluder for NOTES gastrotomy closure.
abstract: BACKGROUND
  The objective of this study is to evaluate the closure of a transgastric natural orifice transluminal endoscopic surgery (NOTES) access using a multilayer extracellular matrix (ECM) occluder in a canine model.
  
  
  METHODS
  Mongrel dogs (n = 4) underwent a transgastric NOTES peritoneoscopy and the gastrotomy was closed by deploying a 2-sided ECM occluder. Animals were killed at 7 days (n = 2) and 8 weeks (n = 2) for macroscopic and microscopic assessment.
  
  
  RESULTS
  All procedures were completed without any complications. No air leaks were detected immediately after the procedure and at 48 hours postoperatively. At 7 days, ECM appeared to be resolved and mild mucosal inflammation was found at the site of gastrotomy. At 8 weeks, the gastrotomy site was macroscopically and microscopically covered with a normal-appearing gastric mucosa. There was an absence of inflammatory cells and no evidence of the ECM.
  
  
  CONCLUSIONS
  The ECM occluder is safe and effective in this "proof-of-concept" preclinical model.
authors.affiliation: *Department of Cardiothoracic Surgery, Division of Thoracic and Foregut Surgery, University of Pittsburgh Medical Center †McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA ‡Department of Surgery, University of Favaloro, Buenos Aires, Argentina.
authors.forename: Alejandro F
authors.initials: AF
authors.lastname: Sanz
authors.forename: Toshitaka
authors.initials: T
authors.lastname: Hoppo
authors.forename: Bart P
authors.initials: BP
authors.lastname: Witteman
authors.forename: Bryan N
authors.initials: BN
authors.lastname: Brown
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Gilbert
authors.forename: Stephen F
authors.initials: SF
authors.lastname: Badylak
authors.forename: Blair A
authors.initials: BA
authors.lastname: Jobe
authors.forename: Alejandro
authors.initials: A
authors.lastname: Nieponice
mesh_terms: D000818:Animals; D020099:Coated Materials, Biocompatible; D004195:Disease Models, Animal; D004285:Dogs; D005743:Gastrectomy / Q000379:methods*; D005753:Gastric Mucosa; D057605:Natural Orifice Endoscopic Surgery / Q000295:instrumentation*; D011474:Prosthesis Design; D013270:Stomach / Q000601:surgery*; D013536:Suture Techniques; D054457:Tissue Scaffolds; D058106:Wound Closure Techniques / Q000295:instrumentation*
chemical_list: D020099:Coated Materials, Biocompatible