Pure endoscopic full-thickness resection with peritoneoscopy and omentectomy

Area of Science:

• Gastroenterology
• Surgical Innovation
• Endoscopic Procedures

Background:

• Endoscopic full-thickness resection (EFTR) offers a minimally invasive approach for gastrointestinal lesions.
• Challenges remain in achieving secure closure of the resection site during EFTR.

Purpose of the Study:

• To evaluate the surgical procedures for pure EFTR using a flexible endoscope.
• To assess the efficacy of a prototype double-arm bar suturing system (DBSS) for closure after EFTR in animal experiments.

Main Methods:

• Six beagles underwent transgastric EFTR, divided into two groups: over-the-scope-clip (OTSC) and DBSS.
• Surgical techniques included duodenal balloon occlusion and a muscle layer thin-cutting method with hyaluronic acid injection.
• Resection site closure was performed using either OTSC or the DBSS prototype.

Main Results:

• The DBSS prototype provided reliable closure of resection sites with absorbable thread.
• Dogs in the DBSS group showed no complications and good health post-procedure (POD 30).
• Two dogs in the OTSC group died due to dehiscence and gastric leaks, with OTSC detachment observed postmortem.

Conclusions:

• Pure EFTR is feasible and safe when systematic methods and the DBSS are employed.
• The DBSS demonstrates high safety for full-thickness resection suturing, supporting potential clinical translation.