Closure of Gastric Perforation with a Novel Tissue Anchoring Device

Abstract

Background: With the increasing use of endoscopic treatments, there is greater risk for creating an iatrogenic perforation in the GI tract. Urgent endoscopic repair with clips has been reported as well-tolerated and a therapeutic option. However, it is difficult to apply clips for secure full thickness closure of large defects Aims: To assess the ability of a tissue anchoring device to close a large iatrogenic gastric perforation in a porcine model. Methods: A dual channel therapeutic scope was used (Olympus America, NY). The prototype tissue anchoring device consisted of two flexible retractable needle catheters and a bifurcated nylon suture with two distal t-tags and one proximal sliding t-tag. Before the procedure, both ends of the suture attached with two distal t-tags were loaded inside of the retractable needle catheters. Full-thickness puncture with each needle separately place each of the two distal t-tags on each side of the perforation. the free proximal tag was then grasped and the sliding T-tag was firmly pushed to cinch the suture. Six pigs were studied under general anesthesia. Two perforations over 2 cm in size were created for each pig along the greater curvature and the anterior wall with a combination of needle knife and sphincterotome. They were each closed with 3-5 tissue anchors sets, depending on the length of the perforation. One week after the repair, follow up endoscopy and necropsy were performed to evaluate treated sites. Results: Twelve perforations were closed with 48 tissue anchors. All animals survived for one week without clinical complications. Follow up endoscopy and necropsy revealed all tissue anchors firmly in place with healed perforations. However, three of twenty four tissue anchors (12.5%) used at the anterior wall penetrated surrounding organs; two penetrated the liver and one penetrated the anterior abdominal wall. Conclusions: Full thickness closure with a new tissue anchoring device successfully repaired large iatrogenic gastric perforations. The preliminary results of this study are encouraging for providing reliable and safe endoscopic closure of iatrogenic perforations.