Related Experiment Video
Updated: Jun 16, 2026
Endoscopic Vacuum Therapy for the Treatment of Anastomotic Leakage after Total Gastrectomy with Esophagojejunostomy
Published on: August 22, 2025
A novel double-endoloop technique for natural orifice transluminal endoscopic surgery gastric access site closure
Tomas Hucl1, Marek Benes, Matej Kocik
1Department of Hepatology and Gastroenterology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
Background:
Effective and safe access site closure is critical for clinical application of natural orifice transluminal endoscopic surgery.
Objective:
The current study evaluated a simple novel technique of gastrotomy closure.
Design:
Feasibility study with a survival animal model.
Setting:
Animal laboratory.
Subjects:
Ten female domestic pigs.
Interventions:
Endoscopic closure of a gastrotomy incision was evaluated in 10 pigs in a survival study. A standard double-channel endoscope was advanced into the peritoneal cavity through an incision made by a needle-knife and an 18-mm dilation balloon. After peritoneoscopy and salpingectomy, gastric closure was performed by using an endoscopic grasper and sequential application of 2 endoloops. After a follow-up period of 1 to 3 weeks, the pigs were killed for postmortem examination.
Main Outcome Measurements:
Feasibility, efficiency, and safety of a novel closure technique.
Results:
Correct positioning and delivery of endoloops was achieved in all animals in a median time of 17 minutes (range 13-25 minutes). All animals survived without complications. Postmortem examination demonstrated patent full-thickness gastric closure without any evidence of infection.
Limitations:
Feasibility study with a small number of subjects in a porcine model.
Conclusion:
Double endoloop technique represents a novel, simple, safe, and efficient means of gastric access site closure in natural orifice transluminal endoscopic surgery.
