Endoluminal full-thickness suture repair of gastrotomy: a survival study

Background: Treatment of perforations and complications related to gastrointestinal (GI) surgery and interventional flexible endoscopy is increasingly performed endoscopically. New devices enabling secure full-thickness GI tract closures through flexible endoscopic platforms have been recently developed. Aim: To assess feasibility of endoscopic closure of a large gastrotomy using a tip-mounted flexible endoscopic suturing device. Methods: Six pigs were involved in this study. Standardized 3-cm full-thickness gastrotomies were created endoscopically in various areas of the gastric wall, in all animals, using monopolar cautery. A peritoneoscopy was performed through the gastrotomy. In four pigs, gastrotomy was repaired with an endoscopic suturing device (OverStitch™, Apollo Medical). Full-thickness suturing was started at the edges of the incision, and a figure-of-eight pattern was used. A dedicated helical tissue grasper combined with endoscopic suction was used to retract incision borders and ensure full-thickness closure. Sutures were locked using a cinching device. In two pigs, the gastrotomy was closed laparoscopically and served as a control. An air leak test was performed. On postoperative day 10 (POD 10), all pigs underwent endoscopy and laparotomy and were euthanized. Results: Mean endoscopic suturing time was 57.5 ± 14.15 min, and four to six sutures were delivered per incision. Laparoscopic suturing time was 8 min. All leak tests were negative. No intraoperative or postoperative complications occurred. On POD 10, all gastrotomies were healed. In one animal, thick adhesions were found surrounding the suture site but no leak was identified. Conclusions: Full-thickness suturing of experimental gastrotomies using the OverStitch™ device is feasible and effective.