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• W1973827534 abstract "Introduction- Perforation of the digestive tract wall is one of the most feared complications in endoscopic resections of epithelial or subepithelial lesions. Aims - Evaluation of an experimental endoscopic closure of gastric perforations on pigs and establishment of guidelines for endoscopic closing sutures. Method-Ten pigs of races Landrace and Large-White were submitted to general anesthesia and upper GI endoscopy. Initially a standardized gastric wall perforation was performed. The opening was made by aspiration of the gastric wall with an end adapter used for rubber band ligation. The resection of the adapter content was performed with a polypectomy snare introduced through a plastic tube attached to the endoscope. As a next step, a metallic endoscopic clip (Hemoclip® - Olympus America Inc., Miami FL ) was placed on the edge of the opening, grasping firmly the muscular layer. After having trapped the clip, the polypectomy snare was pulled through the mouth so as to bring the wound to a spindleshaped form. The closure was achieved by clips placed one by one. Where the muscular layer could not be seen, the closure was made with the mucosa, aiming to catch the wall as deeply as possible. The pneumoperitoneum was emptied with a Verres needle. The animals were sacrificed after 15 days and had their stomach removed for macro and microscopical study. At the same time, the abdominal cavity was evaluated. Results - The suture was performed in all animals, but in only seven (7) of them was the muscular layer clearly attached to both sides of the wound. Nine (9) pigs showed the opening edges firmly coapted and five (5) had an ulcer at the site of the wound. Three pigs appeared to be ill in the postoperative course and showed localized or generalized peritonitis. One (1) died on the 13th day. Conclusions - The endoscopic repair of gastric perforation using clips seems to be feasible and easy. It seems useful to establish some guidelines. After aspiration of gastric contents, the first step would be to work the wound into the shape of a mouth. This strategy will make it easy to clip the edges. It is very important to make the suture grasp the muscular layer. More studies are needed before this technique is used routinely in patients. Introduction- Perforation of the digestive tract wall is one of the most feared complications in endoscopic resections of epithelial or subepithelial lesions. Aims - Evaluation of an experimental endoscopic closure of gastric perforations on pigs and establishment of guidelines for endoscopic closing sutures. Method-Ten pigs of races Landrace and Large-White were submitted to general anesthesia and upper GI endoscopy. Initially a standardized gastric wall perforation was performed. The opening was made by aspiration of the gastric wall with an end adapter used for rubber band ligation. The resection of the adapter content was performed with a polypectomy snare introduced through a plastic tube attached to the endoscope. As a next step, a metallic endoscopic clip (Hemoclip® - Olympus America Inc., Miami FL ) was placed on the edge of the opening, grasping firmly the muscular layer. After having trapped the clip, the polypectomy snare was pulled through the mouth so as to bring the wound to a spindleshaped form. The closure was achieved by clips placed one by one. Where the muscular layer could not be seen, the closure was made with the mucosa, aiming to catch the wall as deeply as possible. The pneumoperitoneum was emptied with a Verres needle. The animals were sacrificed after 15 days and had their stomach removed for macro and microscopical study. At the same time, the abdominal cavity was evaluated. Results - The suture was performed in all animals, but in only seven (7) of them was the muscular layer clearly attached to both sides of the wound. Nine (9) pigs showed the opening edges firmly coapted and five (5) had an ulcer at the site of the wound. Three pigs appeared to be ill in the postoperative course and showed localized or generalized peritonitis. One (1) died on the 13th day. Conclusions - The endoscopic repair of gastric perforation using clips seems to be feasible and easy. It seems useful to establish some guidelines. After aspiration of gastric contents, the first step would be to work the wound into the shape of a mouth. This strategy will make it easy to clip the edges. It is very important to make the suture grasp the muscular layer. More studies are needed before this technique is used routinely in patients." @default.
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• W1973827534 title "3471 Guideline for gastric perforation endoscopic repair using metallic clips." @default.
• W1973827534 doi "https://doi.org/10.1016/s0016-5107(00)14171-9" @default.
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