A novel occluder for endoscopic closure of gastrotomy: an ex vivo and in vivo animal study.
OBJECTIVE
We evaluated the feasibility of a novel occluder for endoscopic closure of natural orifice transluminal endoscopic surgery (NOTES) gastrotomy.


METHODS
The occluder is a self-expandable, membrane-covered, metal structure for endoscopic delivery through gastrointestinal (GI) wall defects. The procedure time and air-tightness of endoscopic closure for a 12-mm perforation were compared for a through-the-scope clip group and an occluder group in an ex vivo animal study. The feasibility and safety of the occluder for the closure of NOTES gastrotomy were also evaluated in an in vivo animal study.


RESULTS
In the ex vivo study, the median procedure time for closure was significantly shorter and the minimum air-leakage pressure was significantly greater in the occluder group than in the endoclip group. In the in vivo study, immediate air-tight sealing was achieved by application of the occluder and there were no serious adverse events. All animals showed spontaneous detachment of the occluder into the gastric lumen and complete healing within 4 - 8 weeks.


CONCLUSIONS
The novel occluder can provide immediate and permanent sealing for NOTES gastrotomy.
Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea,Incheon, Korea.
Ji Hee
JH
Kim
Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Bo-In
BI
Lee
Department of Hospital Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Sung Hak
SH
Lee
Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea,Incheon, Korea.
Joon Sung
JS
Kim
Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Myong Ki
MK
Baeg
Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Jae Myung
JM
Park
Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
In-Seok
IS
Lee
Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea,Incheon, Korea.
Byung-Wook
BW
Kim
Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Sang Woo
SW
Kim
Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea,Incheon, Korea.
Hwang
H
Choi
Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Myung-Gyu
MG
Choi
D000818:Animals; D016099:Endoscopy, Gastrointestinal / Q000295:instrumentation*; D005240:Feasibility Studies; D005260:Female; D005774:Gastrostomy; D057605:Natural Orifice Endoscopic Surgery; D061646:Operative Time; D013270:Stomach / Q000601:surgery*; D013552:Swine; D058106:Wound Closure Techniques / Q000295:instrumentation*