title: Closure of iatrogenic large mucosal and full-thickness defects of the stomach with endoscopic interrupted sutures in in vivo porcine models: are they durable enough?
abstract: BACKGROUND
  In this study, we evaluated the technical feasibility of mucosal approximation of large ulcers via an endoscopic suturing system after endoscopic submucosal dissection (ESD), assessed the durability of these sutures, and compared this technique with serosal apposition of full-thickness gastric wall defects using the same device.
  
  
  METHODS
  Post-ESD ulcers were closed with mucosal apposition in 7 pigs, and endoscopic full-thickness resection (EFTR) defects were closed with serosal apposition in 3 pigs. Pigs recovered for 1 week; they were then euthanized and necropsies were performed.
  
  
  RESULTS
  Primary defect closure was achieved in 85.7% of the post-ESD closures and in 100% of the post-EFTR closures (p = 0.67). All pigs survived for 1 week. At necropsy, sutures had loosened in the post-ESD animals, although only minor deformity of the ulcer edges was observed in all repaired post-ESD ulcers. Meanwhile, all of the post-EFTR defect closures were sustained for 1 week.
  
  
  CONCLUSIONS
  Primary closure of post-therapeutic defects can be accomplished using the device. Inverted serosal apposition provides a more durable and reliable repair than everted mucosal apposition.
authors.affiliation: Division of Gastroenterology & Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan. k-masa@outlook.com.
authors.forename: Masakuni
authors.initials: M
authors.lastname: Kobayashi
authors.affiliation: Department of Endoscopy, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan. kaz_sum@jikei.ac.jp.
authors.forename: Kazuki
authors.initials: K
authors.lastname: Sumiyama
authors.affiliation: Department of Endoscopy, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan. ban1020yamato@yahoo.co.jp.
authors.forename: Yamato
authors.initials: Y
authors.lastname: Ban
authors.affiliation: Department of Endoscopy, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan. ad99061@jikei.ac.jp.
authors.forename: Akira
authors.initials: A
authors.lastname: Dobashi
authors.affiliation: Department of Endoscopy, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan. ohya@jikei.ac.jp.
authors.forename: Tomohiko Richard
authors.initials: TR
authors.lastname: Ohya
authors.affiliation: Department of Pathology, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan. thebandapartasiangothic@yahoo.co.jp.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Aizawa
authors.affiliation: Department of Pathology, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan. shirooka@jikei.ac.jp.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Hirooka
authors.affiliation: Division of Next Generation Endoscopic Intervention, Osaka University, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan. knakajima@gesurg.med.osaka-u.ac.jp.
authors.forename: Kiyokazu
authors.initials: K
authors.lastname: Nakajima
authors.affiliation: Division of Gastroenterology & Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan. tajiri@jikei.ac.jp.|Department of Endoscopy, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan. tajiri@jikei.ac.jp.
authors.forename: Hisao
authors.initials: H
authors.lastname: Tajiri
mesh_terms: D000818:Animals; D004210:Dissection / Q000009:adverse effects; D005240:Feasibility Studies; D005753:Gastric Mucosa / Q000601:surgery*; D005773:Gastroscopy / Q000295:instrumentation*; D007049:Iatrogenic Disease; D012704:Serous Membrane / Q000601:surgery; D013276:Stomach Ulcer / Q000209:etiology / Q000601:surgery*; D013536:Suture Techniques / Q000009:adverse effects / Q000295:instrumentation*; D013552:Swine; D014945:Wound Healing