Elsevier

Gastrointestinal Endoscopy

Volume 56, Issue 5, November 2002, Pages 737-742
Gastrointestinal Endoscopy

New Methods & Materials
A through-the-scope device for suturing and tissue approximation under EUS control

https://doi.org/10.1016/S0016-5107(02)70130-2Get rights and content

Abstract

Background: The ability to place sutures under EUS control might allow development of a new type of transluminal endosurgery. The aim of this study was to develop endoscopic methods for suturing to variable predetermined depths in the wall of the GI tract and to allow fixation of adjacent hollow organs under EUS control. Methods: A suturing device was constructed for suturing under EUS control to any desired depth. Sutures can also be placed into hollow or solid organs within 5 cm of the endoscope tip. The device allows multiple sutures to be placed without withdrawing the endoscope. Stitching, knot-tying, and thread-cutting are achieved through a 2.8-mm accessory channel. Results: Multiple (>100) sutures were placed in predetermined gut wall layers in pigs. Sutures were placed in the gallbladder (n = 7) and small intestine (n = 8) to fix the gallbladder/small intestine to the stomach and allow traction for the insertion of stents and other devices through the 2 lumens. Conclusion: A new method for stitching under flexible EUS control is described. This technology was used to place sutures at precise depths in the GI tract. It allowed fixation of other organs to the accessible GI tract for various purposes including delivery of stents and devices for creating anastomoses.

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).

. A, Drawings of tilt tag with sprung forked tail. A tilt tag is a hollow metal cylinder with a central hole through which a thread is passed and attached to the tag. The tilt tag fits inside the needle. The springing of its forked tail prevents the tilt tag from falling out of the host needle prematurely. Force exerted on the

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.

Cited by (0)

Reprint requests: P. Swain, Department of Gastroenterology, Royal London Hospital-Whitechapel, London W1-1BB, United Kingdom.

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