CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(07): E1049-E1054
DOI: 10.1055/a-1451-3854
Innovation forum

Applying basic principles of surgery may pave the way for more effective endoscopic bariatric techniques

Kiyoshi Hashiba
1  Department of Digestive Endoscopy, Hospital Sírio-Libanês, São Paulo, Brazil
,
Carlos Alberto Cappellanes
1  Department of Digestive Endoscopy, Hospital Sírio-Libanês, São Paulo, Brazil
,
Pablo Rodrigo de Siqueira
1  Department of Digestive Endoscopy, Hospital Sírio-Libanês, São Paulo, Brazil
,
Antonio Carlos Conrado
2  Endoscopy Unit, Hospital da Restauração – Recife, Brazil
,
Bruno Ribeiro
3  Endoscopy Division, UF Health Jacksonville – Jacksonville, Florida, United States
,
Fernando Pavinato Marson
1  Department of Digestive Endoscopy, Hospital Sírio-Libanês, São Paulo, Brazil
,
Bruno Gregnanin Pedron
1  Department of Digestive Endoscopy, Hospital Sírio-Libanês, São Paulo, Brazil
› Author Affiliations

Abstract

Background and study aims In the last decade, gastroenterologists have been attempting to use endoscopy to reproduce the great success of traditional surgical suture techniques. Despite recent advances, we still lack a reliable method that results in a permanent suture with minimal incidence of suture failure. This was an experimental study in pigs with an innovative technique that applied basic surgical concepts to endoscopy to evaluate the effectiveness of a novel suture technique.

Methods The procedures were performed on six live pigs under general anesthesia. Endoscopic mucosal resection (EMR) first was performed in the stomach, exposing the submucosal or muscularis propria layers. A novel device, a transparent chamber cap (DASE), was developed to aspirate the gastric wall, allowing the sutures to reach deep layers. The aspiration was performed with a standard gastroscope to which the novel cap was distally attached. Three sutures aligned were defined as a plication. Each pig received two or three plications and was placed on a liquid diet for 14 days after the procedure. The pigs were sacrificed at 4 and 8 weeks and the sutures were reviewed.

Results The technique was feasible in all animals. Of 16 plications, only one failed. One perforation occurred after EMR. There were no other complications or adverse events. Permanent fusion of the gastric wall was confirmed by histology in all cases.

Conclusions This study showed that basic principles of surgery can be applied endoscopically to ensure a permanent suture with reduced chances of failure. These findings can help to pave the way for more effective bariatric endoscopic techniques.



Publication History

Received: 20 August 2020

Accepted: 15 February 2021

Publication Date:
17 June 2021 (online)

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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