Endoscopic full-thickness resection:: circumferential cutting method

Background: Endoscopic full-thickness resection (EFTR) at flexible endoscopy might allow less-invasive removal of more deeply penetrating cancers that have not spread to the serosal surface and more complete histologic examination of the excised tissue. Objective: A method for closure of full-thickness defects in the stomach wall would be valuable for other endosurgical applications. Setting: A method that uses an end cap and band-ligation without prior injection of saline solution to perform EFTR gave good results and was safe in pig studies. There is a size limitation of cancers that can be resected en bloc when using this method. The depth of resection was also variable. Design and Interventions: EFTR was achieved by circumferential cutting with a sphincterotome and a snare. A prototype bidirectional cutter was tested. Sutured closure was accomplished by using a sheathed needle, a metal tag, and a thread at the tip, passed through a 2.8-mm accessory channel. Knot-tying devices secured the sutured defect. Main Outcome Measurements: EFTR was studied in nonsurvival (n = 4) and survival (n = 8) experiments in pigs. Results: Full-thickness specimens were resected from the gastric wall (100%, 12/12), and the defects were closed by using sewing and knot-tying devices (100%, 12/12). Limitations: A healing ulcer at the suturing site was evident at follow-up endoscopy in the survival experiments. Bleeding, which was stopped by suturing, occurred in 1 pig (8.3%, 1/12). All pigs survived these experiments without complications (100%, 8/8). Conclusions: Circumferential EFTR was feasible and appeared safe in survival experiments. This method might allow larger and deeper resection of tumors in the gastric wall.