title: Endoscopic ultrasound-guided puncture suture device versus metal clip for gastric defect closure after endoscopic full-thickness resection: A randomized, comparative, porcine study.
abstract: OBJECTIVE
  The secure closure of the wall defect is a critical stage of endoscopic full-thickness resection (EFTR). The aim of this study was to compare the closure of post-EFTR defects using an endoscopic ultrasound-guided puncture suture device (PSD) with the metal clip (MC) technique in a randomized, comparative, porcine study.
  
  
  METHODS
  We performed a randomized comparative survival study that included 18 pigs. The circular EFTR defects with a diameter of approximately 20 mm were closed with either a PSD or MC. Serum levels of interleukin-6 (IL-6) were determined preoperatively and on a postoperative day (POD) 1, 3, and 7. Three animals from each group were sacrificed at the end of the 7 th , 14 th , and 30 th POD. Tissue samples retrieved from the closure sites were examined macroscopically and microscopically.
  
  
  RESULTS
  Resection and closure were performed in 18 pigs (100%) without major perioperative complications. The mean closure time was significantly longer in the MC group than in the PSD group (25.00 ± 3.16 min vs. 1.56 ± 0.39 min; P < 0.05). Preoperative and POD 7 serum levels of IL-6 did not differ between the two groups. However, on POD 1, the IL-6 levels were observed to be significantly greater in the MC group than in the PSD group (P < 0.005). No significant differences between the PSD and MC groups were observed at necropsy.
  
  
  CONCLUSIONS
  In this in vivo porcine model, PSD is a feasible device that achieves post-EFTR defect closure with a much shorter closure time and with less immunological responses than the MC technique.
authors: Endoscopy Center, Shengjing Hospital, China Medical University, Liaoning Province, China.
authors: Beibei
authors: B
authors: Sun
authors: Endoscopy Center, Shengjing Hospital, China Medical University, Liaoning Province, China.
authors: Jintao
authors: J
authors: Guo
authors: Endoscopy Center, Shengjing Hospital, China Medical University, Liaoning Province, China.
authors: Nan
authors: N
authors: Ge
authors: Endoscopy Center, Shengjing Hospital, China Medical University, Liaoning Province, China.
authors: Siyu
authors: S
authors: Sun
authors: Endoscopy Center, Shengjing Hospital, China Medical University, Liaoning Province, China.
authors: Sheng
authors: S
authors: Wang
authors: Endoscopy Center, Shengjing Hospital, China Medical University, Liaoning Province, China.
authors: Xiang
authors: X
authors: Liu
authors: Endoscopy Center, Shengjing Hospital, China Medical University, Liaoning Province, China.
authors: Guoxin
authors: G
authors: Wang
authors: Endoscopy Center, Shengjing Hospital, China Medical University, Liaoning Province, China.
authors: Linlin
authors: L
authors: Feng