J Dig Dis. 2014 Feb;15(2):96-101. doi: 10.1111/1751-2980.12110.
To investigate surgical procedures for pure endoscopic full-thickness resection (EFTR) using a flexible endoscope and a prototype of a full thickness suturing device in animal experiments.
Six beagles were divided into two groups: sutured with over-the-scope-clip (OTSC group, n = 3) and with a prototype of the double-arm bar suturing system (DBSS group, n = 3). The peritoneoscopy, omentectomy and EFTR procedures were performed through the transgastric route. We examined the surgical procedures required to accomplish pure EFTR and survival rates of these dogs after EFTR.
The duodenal balloon occlusion method maintained a sufficient endoscopic view during peritoneoscopy. Grooves of 10-mm wide were created around the tumor down to the third layer for treating all blood vessels and adding landmark for full-thickness resection lines. Using the muscle layer thin-cutting method, hyaluronic acid was locally injected into the muscle layer and fine incisions were made. Creating tiny perforations provided safe access to the abdominal cavity. Although it was difficult to suture the resected site safely in the OTSC group, the DBSS prototype was useful and reliable for closing there section sites with 3-0 absorbable thread. After EFTR there were no complications in the DBSS group and the dogs were in good health on POD 30, whereas in the OTSC group two dogs died due to dehiscence and gastric juice leaks. Postmortem examinations showed abscess around the suturing sites and two OTSC were detached from the suturing sites.
Pure EFTR is feasible with DBSS when systematic methods are established. The high safety of full-thickness resection suturing will permit their clinical application in the near future.
在动物实验中，使用软性内镜和全层缝合装置原型，研究全层内镜下完整切除术（EFTR）的手术方法。
将 6 只比格犬分为两组：使用过内镜缝合夹（OTSC 组，n = 3）和双臂杆缝合系统原型（DBSS 组，n = 3）进行缝合。通过经胃途径进行腹腔镜检查、网膜切除术和 EFTR 手术。我们检查了完成纯 EFTR 所需的手术步骤以及这些狗在 EFTR 后的存活率。
十二指肠球囊阻塞法在腹腔镜检查过程中保持了足够的内镜视野。在肿瘤周围创建了 10mm 宽的凹槽，一直切到第三层，以治疗所有血管并添加全层切除线的标记。使用肌肉层薄切法，将透明质酸局部注入肌肉层并进行精细切割。创建微小穿孔为进入腹腔提供了安全的途径。虽然在 OTSC 组中安全缝合切除部位很困难，但 DBSS 原型对于使用 3-0 可吸收缝线闭合该部位非常有用且可靠。在 EFTR 后，DBSS 组没有出现并发症，并且这些狗在第 30 天的 POD 时状态良好，而在 OTSC 组中，两只狗因缝合部位裂开和胃液泄漏而死亡。尸检显示缝合部位周围有脓肿，两个 OTSC 从缝合部位脱落。
当建立系统方法时，DBSS 可实现纯 EFTR。全层切除缝合的高安全性将允许它们在不久的将来在临床上应用。
