Gastric full-thickness suturing during EMR and for treatment of gastric-wall defects (with video)

BackgroundThe endoscopic full-thickness Plicator device was initially developed to provide an endoscopic treatment option for patients with GERD. Because the endoscopic full-thickness Plicator enables rapid and easy placement of transmural sutures, comparable with surgical sutures, we used the Plicator device for endoscopic treatment or prevention of GI-wall defects.ObjectiveTo describe the outcomes and complications of endoscopic full-thickness suturing during EMR and for the treatment of gastric-wall defects.DesignA report of 4 cases treated with the endoscopic full-thickness suturing between June 2006 and April 2007.SettingA large tertiary-referral center.PatientsFour subjects received endoscopic full-thickness suturing. The subjects were women, with a mean age of 67 years.InterventionsOf the 4 subjects, 3 received endoscopic full-thickness suturing during or after an EMR. One subject received endoscopic full-thickness suturing for treatment of a fistula.Main Outcome MeasurementsPrimary outcome measurements were clinical procedural success and procedure-related adverse events.ResultsThe mean time for endoscopic full-thickness suturing was 15 minutes. In all cases, GI-wall patency was restored or ensured, and no procedure-related complications occurred. All subjects responded well to endoscopic full-thickness suturing.LimitationsThe resection of one GI stromal tumor was incomplete. Because of the Plicator's 60F distal-end diameter, endoscopic full-thickness suturing could only be performed with the patient under midazolam and propofol sedation. The durable Plicator suture might compromise the endoscopic follow-up after EMR.ConclusionsThe endoscopic full-thickness Plicator permits rapid and easy placement of transmural sutures and seems to be a safe and effective alternative to surgical intervention to restore GI-wall defects or to ensure GI-wall patency during EMR procedures.