Endoscopic full-thickness resection using an endoluminal-suturing device: a proof-of-concept study

Area of Science:

• Gastroenterology
• Surgical Innovation
• Endoscopic Procedures

Background:

• Endoscopic full-thickness resection (EFTR) offers solutions for challenging gastrointestinal resections.
• Existing EFTR techniques and tools require further evaluation for optimal application.
• Limitations of endoscopic submucosal dissection necessitate advanced endoscopic techniques.

Purpose of the Study:

• To assess the safety and feasibility of non-exposed EFTR.
• To evaluate a novel endoscopic suturing device for gastric lesion resection.
• To determine the efficacy of the triangulation platform in achieving R0 resection.

Main Methods:

• Gastric lesions in pigs were resected using the Endomina platform and a triangulation suturing device.
• Virtual lesions exceeding 20 mm were created and encircled with sutures.
• Internalized lesions were subsequently excised using a needle knife after suture tightening.

Main Results:

• R0 resection was achieved for all large gastric lesions (42–60 mm).
• An initial perforation led to procedural modifications, including suture shortening and reinforcement.
• Procedure duration decreased by 50% from the first to the fourth case.
• Histological analysis confirmed complete full-thickness resection.

Conclusions:

• EFTR with the evaluated triangulation platform is feasible for lesions larger than 20 mm.
• The study identified areas for procedural simplification prior to human trials.
• Further refinement of the technique may enhance its safety and efficiency.