New Methods & MaterialsA through-the-scope device for suturing and tissue approximation under EUS control☆
Section snippets
Materials and methods
A suturing device was constructed that allows placement of a suture under EUS control to any desired depth in the stomach, esophageal, or duodenal wall (Figs. 1 and 2).
Results
Multiple (~100) sutures were placed in the different wall layers of postmortem specimens of esophagus, stomach, and duodenum. Sutures were placed through the duodenal wall and into small intestine and gallbladder (Fig. 4, Fig. 5). The force required to pull the stitches out or break the thread was measured at 0.825 kg for the small bowel and 1.250 to 1.625 kg in the stomach depending on the area tested. The exerted force pulled the stitches through the small bowel wall and broke the thread in
Discussion
A new method for suturing described in this study allows placement of sutures under real-time EUS imaging to any desired depth within the GI tract wall, or into structures beyond the wall such as the gallbladder and small intestine. Multiple sutures can be placed without withdrawing the endoscope. The latter capability distinguishes this new method from commercially available flexible endoscopic sewing devices with which 1 or at most 2 sutures can be placed before the instrument has to be
Disclosure:
Supported by Special Trustees of the Royal London Hospital.
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Reprint requests: P. Swain, Department of Gastroenterology, Royal London Hospital-Whitechapel, London W1-1BB, United Kingdom.