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Endoscopy 2009; 41(12): 1056-1061
DOI: 10.1055/s-0029-1215241
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Randomized controlled trial comparing endoscopic clips and over-the-scope clips for closure of natural orifice transluminal endoscopic surgery gastrotomies

D. von  Renteln1 , M.  C.  Vassiliou1 , 2 , R.  I.  Rothstein1
  • 1Department of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
  • 2Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
Further Information

Publication History

submitted 20 April 2009

accepted after revision 16 September 2009

Publication Date:
06 November 2009 (online)

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Commentaire de travail de D. von Renteln et al., pp. 1056Endoscopy 2009; 41(12): 1105-1105
DOI: 10.1055/s-0032-1306762

Background and study aim: Secure and reliable endoscopic closure is of paramount importance before clinical introduction of transgastric natural orifice transluminal endoscopic surgery (NOTES). Gastrotomy closure in humans using standard endoclips has been reported. The aim of this study was to assess the safety of standard endoclip closure and to compare it to a new over-the-scope clip (OTSC) specifically designed for gastrotomy closure.

Material and methods: Gastric wall puncture and balloon dilation followed by peritoneoscopy was carried out in 20 female swine. After randomization, closure of the gastric incision was performed using a tissue approximation grasper and either endoclips or OTSCs.

Results: Mean (± SD) time for gastrotomy closure using endoclips was 31.5 ± 24.2 minutes (range 8 – 88 minutes) compared with 8.5 ± 9.1 minutes (range 2 – 31 minutes) using OTSC (P = 0.002). No intraoperative complications occurred. Laparoscopic leak tests with insufflation and saline immersion demonstrated three minor leaks and one major leak in the endoclip closures. No leaks were observed in the OTSC group. At necropsy, complete sealing of the gastrotomy sites was found in all OTSC closures. Small, localized perigastric abscesses were observed in two animals in the OTSC group and in three animals in the endoclip group. One animal in the endoclip group was sacrificed prematurely due to signs of sepsis and was found to have gross peritonitis secondary to a leak. At necropsy, evidence of peritonitis was identified in two other animals in the endoclip group.

Conclusion: NOTES gastrotomy closure using standard endoclips, even with a tissue approximation grasper, is associated with an increased risk of leakage and intra-abdominal infection compared with OTSC. The significance of perigastric abscesses, which were seen in both groups, warrants further investigation.

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R. I. RothsteinMD 

Section of Gastroenterology and Hepatology
Dartmouth-Hitchcock Medical Center

1 Medical Center Drive
Lebanon
NH 03756
USA

Fax: +1-603-650-5225

Email: richard.rothstein@dartmouth.edu

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