Endoscopic full-thickness resection: circumferential cutting method

• DOI: 10.1016/j.gie.2005.12.039
• Publication Date: 2006-07-21T17:46:20Z
• Authors: Keiichi Ikeda; C. Alexander Mosse; Per-Ola Park; Annette Fritscher...; Maria Bergström; Tim Mills; Hisao Tajiri; C. Paul Swain
• Keywords: 03 medical and health sciences; 0302 clinical medicine; Stomach Neoplasms; Swine; Hemostasis, Endoscopic; Suture Techniques; Animals; Feasibility Studies; Endoscopy, Gastrointestinal; 3. Good health

Endoscopic full-thickness resection (EFTR) at flexible endoscopy might allow less-invasive removal of more deeply penetrating cancers that have not spread to the serosal surface and more complete histologic examination of the excised tissue.A method for closure of full-thickness defects in the stomach wall would be valuable for other endosurgical applications.A method that uses an end cap and band-ligation without prior injection of saline solution to perform EFTR gave good results and was safe in pig studies. There is a size limitation of cancers that can be resected en bloc when using this method. The depth of resection was also variable.EFTR was achieved by circumferential cutting with a sphincterotome and a snare. A prototype bidirectional cutter was tested. Sutured closure was accomplished by using a sheathed needle, a metal tag, and a thread at the tip, passed through a 2.8-mm accessory channel. Knot-tying devices secured the sutured defect.EFTR was studied in non-survival (n = 4) and survival (n = 8) experiments in pigs.Full-thickness specimens were resected from the gastric wall (100%, 12/12), and the defects were closed by using sewing and knot-tying devices (100%, 12/12).A healing ulcer at the suturing site was evident at follow-up endoscopy in the survival experiments. Bleeding, which was stopped by suturing, occurred in 1 pig (8.3%, 1/12). All pigs survived these experiments without complications (100%, 8/8).Circumferential EFTR was feasible and appeared safe in survival experiments. This method might allow larger and deeper resection of tumors in the gastric wall.