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THE QUEEN’S CLOSURE: A NOVEL TECHNIQUE FOR CLOSURE OF ENDOSCOPIC GASTROTOMY FOR NATURAL ORIFICE TRANSLUMENAL ENDOSCOPIC SURGERY
L Hookey, B Bielawska, V Khokhotva, D Jalink, D Hurlbut, A Samis, D Mercer
Gastrointestinal Diseases Research Unit, Queen's University, Kingston, Ontario
Aims: Finding a reliable, safe, adaptable method of closing gastrotomies for NOTES procedures has been a major challenge facing this new clinical area. The Queen's NOTES Group has designed a novel endoscopic method of closing gastrotomies which involved using polyloop polyp ligature devices and endoscopic clips. The current study describes the technique and a pilot study of leak testing it versus hand sewn suture closure.
Methods: Ten fresh pig stomachs were used, five for each technique. A 16 mm endoscopic gastrotomy was performed on the anterior wall of each. Five stomachs were then closed using the Queen's Closure technique, and five with a hand sewn double layer suture technique. The stomachs were then connected to a water infusion device with sensitive pressure monitoring and were filled until leakage was detected at the closure site.
Results: The closures were all technically successful. The mean time for each gastrotomy and closure using the Queen's Closure technique was 1.2 hours. The mean leak pressure for the Queen's Closure was 51.8mm Hg and for the hand sewn suture technique it was 80.8 mm Hg (p<0.001). All of the Queen's closure leaks occurred after the endosclips released the mucosa.
Conclusions: The Queen's Closure technique holds promise as a reliable transferable technique for closing gastrotomies. The technique may be even miore effective in live tissue, which would allow better tissue adherence by the endoscopic clips. Further study is necessary to evaluate its effects in live models.