von Renteln Daniel, Schmidt Arthur, Riecken Bettina, Caca Karel
Medizinische Klinik I, Klinikum Ludwigsburg, Ludwigsburg, Germany.
Gastrointest Endosc. 2008 Apr;67(4):738-44. doi: 10.1016/j.gie.2007.10.051. Epub 2008 Mar 4.
The endoscopic full-thickness Plicator device was initially developed to provide an endoscopic treatment option for patients with GERD. Because the endoscopic full-thickness Plicator enables rapid and easy placement of transmural sutures, comparable with surgical sutures, we used the Plicator device for endoscopic treatment or prevention of GI-wall defects.
To describe the outcomes and complications of endoscopic full-thickness suturing during EMR and for the treatment of gastric-wall defects.
A report of 4 cases treated with the endoscopic full-thickness suturing between June 2006 and April 2007.
A large tertiary-referral center.
Four subjects received endoscopic full-thickness suturing. The subjects were women, with a mean age of 67 years.
Of the 4 subjects, 3 received endoscopic full-thickness suturing during or after an EMR. One subject received endoscopic full-thickness suturing for treatment of a fistula.
Primary outcome measurements were clinical procedural success and procedure-related adverse events.
The mean time for endoscopic full-thickness suturing was 15 minutes. In all cases, GI-wall patency was restored or ensured, and no procedure-related complications occurred. All subjects responded well to endoscopic full-thickness suturing.
The resection of one GI stromal tumor was incomplete. Because of the Plicator's 60F distal-end diameter, endoscopic full-thickness suturing could only be performed with the patient under midazolam and propofol sedation. The durable Plicator suture might compromise the endoscopic follow-up after EMR.
The endoscopic full-thickness Plicator permits rapid and easy placement of transmural sutures and seems to be a safe and effective alternative to surgical intervention to restore GI-wall defects or to ensure GI-wall patency during EMR procedures.
内镜全层缝合器最初是为胃食管反流病患者提供一种内镜治疗选择而开发的。由于内镜全层缝合器能够快速、轻松地放置透壁缝线，与手术缝线相当，我们使用该缝合器进行内镜治疗或预防胃肠道壁缺损。
描述内镜下黏膜切除术（EMR）期间内镜全层缝合及治疗胃壁缺损的结果和并发症。
2006年6月至2007年4月间4例接受内镜全层缝合治疗的病例报告。
一家大型三级转诊中心。
4名受试者接受了内镜全层缝合。受试者均为女性，平均年龄67岁。
4名受试者中，3名在EMR期间或之后接受了内镜全层缝合。1名受试者接受内镜全层缝合以治疗瘘管。
主要观察指标为临床手术成功率和与手术相关的不良事件。
内镜全层缝合的平均时间为15分钟。在所有病例中，胃肠道壁通畅得以恢复或确保，且未发生与手术相关的并发症。所有受试者对内镜全层缝合反应良好。
1例胃肠道间质瘤切除不完全。由于缝合器远端直径为60F，内镜全层缝合只能在患者接受咪达唑仑和丙泊酚镇静的情况下进行。耐用的缝合器缝线可能会影响EMR后的内镜随访。
内镜全层缝合器允许快速、轻松地放置透壁缝线，似乎是手术干预的一种安全有效的替代方法，可用于恢复胃肠道壁缺损或在EMR手术期间确保胃肠道壁通畅。
