Mucosal apposition in endosclopic suturing

Background. The proliferation of minimally invasive surgery has led to the development of numerous entirely intracorporeal endoscopic suturing techniques. These techniques allow for simple apposition of the GI mucosa. It is yet to be determined whether this results in long-term mucosal apposition. This study was designed to determine whether the current techniques of endoscopic suturing necessitate preliminary mucosal manipulation. Methods: Seven dogs underwent laparotomy and gastrotomy to expose the proximal gastric mucosa. Three different suturing techniques were used to appose adjacent tissue folds: simple mucosal apposition, electrosurgical mucosal ablation before closure, and mucosal resection before closure. Apposition sites were scored histologically, based on tissue healing after 2 weeks. Results: Mucosal ablation before tissue apposition resulted in significantly greater healing compared with simple apposition and resulted in histologic scoring similar to that for mucosal resection. The mean histologic score after ablation was 1.5, vs. 1.25 after mucosal resection, and 0.9 for sites closed simply (p = 0.02). Conclusions: Endoscopic suturing techniques may one day offer an alternative to surgical treatment in the management of numerous GI conditions. As this modality evolves, the incorporation of target tissue ablation or mucosal resection before tissue apposition requires consideration. Human studies evaluating the safety and long-term efficacy of these modifications are necessary.