Gastrointestinal endoscopy · 2007
Endoscopic pyloroplasty with full-thickness transgastric and transduodenal myotomy with sutured closure.
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Park Per-Ola, Bergström Maria, Ikeda Keiichi, Fritscher-Ravens Annette, Mosse Sandy, Kochman Michael, Swain Paul
Аннотация
BACKGROUND: Pyloroplasty with myotomy and sutured closure is a surgical treatment for gastric outlet obstruction. It has not been previously performed at flexible endoscopy.
OBJECTIVE: To develop and test a method for performing a sutured pyloroplasty at flexible endoscopy.
DESIGN: A Heinicke-Miculicz pyloroplasty was performed, forming a linear myotomy through the pylorus from the gastric side into the duodenal bulb. This was subsequently sutured transversely to increase the opening. The operation was performed in 3 nonsurvival studies in pigs. The safety and the efficacy was then studied in 7 animals followed for up to 4 weeks after the procedure.
SETTING: The studies were performed in experimental surgical units in Gothenburg, Sweden, and London, UK.
INTERVENTIONS: A linear needle-knife incision was made through the pylorus; full-thickness sutures, by using a new T-tag and polypropylene thread suturing system through a flexible gastroscope, were placed to close the incision transversely. In 2 pigs, the prepyloric bulge was excised before the pyloroplasty.
RESULTS: Pyloroplasty was readily accomplished at flexible endoscopy in the 3 nonsurvival studies. Six of 7 pigs that survived in this study for periods of 7 to 28 days, recovered well, without complications. One pig (with bulge removal) developed gastric retention. The pyloric opening was increased; it was then easy to enter the duodenum at follow-up endoscopy.
LIMITATIONS: This method has yet to be studied clinically.
CONCLUSIONS: Pyloroplasty with full-thickness pyloromyotomy and transverse closure of a linear myotomy was accomplished by using a simple flexible endosurgical technique to test a new flexible suturing system.
OBJECTIVE: To develop and test a method for performing a sutured pyloroplasty at flexible endoscopy.
DESIGN: A Heinicke-Miculicz pyloroplasty was performed, forming a linear myotomy through the pylorus from the gastric side into the duodenal bulb. This was subsequently sutured transversely to increase the opening. The operation was performed in 3 nonsurvival studies in pigs. The safety and the efficacy was then studied in 7 animals followed for up to 4 weeks after the procedure.
SETTING: The studies were performed in experimental surgical units in Gothenburg, Sweden, and London, UK.
INTERVENTIONS: A linear needle-knife incision was made through the pylorus; full-thickness sutures, by using a new T-tag and polypropylene thread suturing system through a flexible gastroscope, were placed to close the incision transversely. In 2 pigs, the prepyloric bulge was excised before the pyloroplasty.
RESULTS: Pyloroplasty was readily accomplished at flexible endoscopy in the 3 nonsurvival studies. Six of 7 pigs that survived in this study for periods of 7 to 28 days, recovered well, without complications. One pig (with bulge removal) developed gastric retention. The pyloric opening was increased; it was then easy to enter the duodenum at follow-up endoscopy.
LIMITATIONS: This method has yet to be studied clinically.
CONCLUSIONS: Pyloroplasty with full-thickness pyloromyotomy and transverse closure of a linear myotomy was accomplished by using a simple flexible endosurgical technique to test a new flexible suturing system.