Original articleExperimental endoscopyGastric wall healing after NOTES procedures: closure with endoscopic clips provides superior histological outcome compared with threaded tags closure

BackgroundClosure of the transgastric access to the peritoneal cavity is a critical step in natural orifice transluminal endoscopic surgery (NOTES).ObjectiveTo perform a direct comparison of the histological healing post clips and threaded tags (T-tags) closure after transgastric NOTES procedures.Setting:Design and InterventionTwelve survival porcine experiments. After standardized endoscopic gastric wall puncture, balloon-dilation, and transgastric peritoneoscopy, closure of the gastric wall was performed with either clips or T-tags. Necropsy at 14 days was performed for histological evaluation of 2-mm interval transversal cross sections of the gastrotomy site.Main Outcome MeasurementsHistological healing of the gastric wall opening.ResultsEndoscopic closure of the gastrotomy was successfully achieved in all 12 animals, followed by an uneventful 2-week clinical follow-up. Transmural healing was seen in 3 (75%) animals after clip closure compared with only 1 (12.5%) in the group with T-tag closure (P = .06). Gastric wall muscular bridging was observed in 4 (100%) animals with clip closure compared with only 1 (12.5%) in the group with T-tag closure (P = .01).LimitationsAnimal model with short-term follow-up.ConclusionsEndoscopic clip closure results in a layer-to-layer transmural healing of the gastric wall. In contrast, T-tag gastric wall plication impairs gastric layer bridging. These findings might guide the future design of new endoscopic devices and techniques for gastrotomy closure after NOTES procedures.