FEASIBILITY AND EFFECTIVENESS OF NATURAL ORIFICE TRANSLUMINAL ENDOSCOPIC SURGERY WITH ENDOCRAB SYSTEM FOR STOMACH PERFORATION MODEL: EX-VIVO PORCINE STUDY

초록

Gastrointestinal tract perforation has become more common due to the rise of endoscopy, with a high mortality rate. Numerous closure methods have been devised for natural orifice transluminal endoscopic surgery, including Through-the-Scope Clip (TTSC) and Overstitch system, offering promise but also limitations. The current study aims to compare the feasibility and effectiveness of mucosal-submucosal suturing using a newly designed suture device with TTSC and manual suturing in an ex-vivo stomach wall perforation model. A total of 30 perforation models of porcine stomach were used in this study. 10 stomachs were used for each closure technique, TTSCs, full-thickness hand sutures, and the proposed suture system (ENDOCRAB). TTSCs and ENDOCRAB techniques were performed using a one-channel endoscope, and the hand sutures were performed from outside of the model. Air leakage pressure and procedure time were measured to compare the closure strength and effectiveness of each technique. The mean air leakage pressure was 73.6±21.6, 118.5±41.7, and 127.4±30.2 mmHg for TTSCs, ENDOCRAB, and full-thickness hand sutures, respectively. The stomachs closed by ENDOCRAB exhibited significantly higher air leakage pressure than TTSC-treated stomachs(P=0.012), and no significant difference with full-thickness hand sutures(P=0.812). The mean procedure time was 1,334.0±777.1, 1,134.2±567.7, and 468.2±123.1 s for TTSCs, ENDOCRAB, full-thickness hand sutures, respectively. The stomachs closed by ENDOCRAB exhibited significantly longer procedure time than full-thickness hand sutures(P=0.014), and no significant difference with TTSCs(P=0.882). With comparable closure strength to full-thickness hand sutures and a procedure time akin to that of TTSCs, ENDOCRAB proves highly effective in mucosal-submucosal suturing.