3478 Endoscopic gastroesophageal suturing: does addition of cautery aid plication persistence?

• Published in: Gastrointestinal endoscopy Vol. 51; no. 4; p. AB104
• Main Authors: Filipi, Charles J., Dunne, Donal, Sweeney, Sharon, Dieselman, Ken, Baluyut, Art, Lehman, Glen A.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.04.2000
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/S0016-5107(00)14178-1

Background: Plication formation with the Swain endoscopic sewing device (BESS)⁎⁎Bard Endoscopic Sewing Systemtypically involves suturing together two gastric mucosal folds. Animal and human observations have rarely noted tissue growth between opposing folds of the plication. Application of limited cautery to such folds has been proposed as a method to promote tissue bridging growth and plication persistence. This theory was tested in the dog animal model. Methods: Mongrel dogs were studied in two series. 2.0 Proline suture was used for all animals. Group 1: 2 dogs underwent transoral endoscopic BESS plication placement in the gastric body and cardia. Two-thirds of the plications had 2-4 sec Bicap cautery (25 watts via 7Fr probe) between the folds. Dogs stayed on a liquid diet for 2 weeks and were sacrificed at 4 weeks. Group 2 dogs had open laparotomy and gastrotomy with BESS plication placement including placement of a 1 cm diameter metal ring between plications to later test plication adherence. Cautery was applied at the mucosal fold edges between plications variably at 30 or 50 watts applied for 3-6 sec. Animals received Zantac 150 mg b.i.d. at 30 days and were then sacrificed. See table. Summary: Addition of cautery to mucosal plications has a higher frequency of mucosal bridging in the short-term dog model when compared to historical controls (no bridging). Bridge formation frequency was variable occurring in 12-71% of subgroups. Conclusions: Studies assessing the therapeutic efficacy of similar studies in humans is awaited. Further studies defining optimal cautery or other scar-producing techniques are needed.