Endoscopic pyloroplasty with full-thickness transgastric and transduodenal myotomy with sutured closure.

TY - JOUR

T1 - Endoscopic pyloroplasty with full-thickness transgastric and transduodenal myotomy with sutured closure.

AU - Park, Per-Ola

AU - Bergström, Maria

AU - Ikeda, Keiichi

AU - Fritscher Ravens, Annette

AU - Mosse, Sandy

AU - Kochman, Michael

AU - Swain, Paul

PY - 2007

Y1 - 2007

N2 - 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.

AB - 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.

M3 - SCORING: Zeitschriftenaufsatz

VL - 66

SP - 116

EP - 120

JO - GASTROINTEST ENDOSC

JF - GASTROINTEST ENDOSC

SN - 0016-5107

IS - 1

M1 - 1

ER -