09- 46, Table 3) OP was introduced for endoscopic gastroduodenal

09-.46, Table 3). OP was introduced for endoscopic gastroduodenal perforation repair in 1998 with satisfactory results37 and 38 BIBF1120 and soon proved effective for gastric perforation repair in pigs.29 A larger prospective randomized trial later confirmed the safety and reliability of OP for large-sized gastroduodenal perforation repair.28 In 2009, a porcine study reported the technical feasibility of using OP for NOTES gastric closure.30 However, the value of this novel closure approach remains unclear because only the negative control of gastrotomy by endoscopic full-thickness

resection without closure was used in this pilot exploratory study. Therefore, we conducted this study to assess the technical aspects and the clinical and histologic outcomes of various gastrotomy closure methods using a canine model. We found that omentoplasty is easier and more reliable for NOTES gastrotomy closure than endoclips alone and offers a similar safety and efficacy profile as OTSC and hand-suturing closures. Endoclips have been widely used to treat GI bleeding and mucosal

defects after mucosa resection by endoscopists. It was first applied to close NOTES access by Kalloo et al39 in 2004. Endoclips may not be an optimal option for NOTES closure despite Avasimibe price some favorable results reported in previous studies20 because it can only achieve a closure of the superficial mucosa layer, not a full-thickness closure, as reported here and elsewhere.22 and 24 The HX-5L endoclips used in the present study had a limited wingspan and shorter duration of attachment, compared with Resolution clips (Boston Scientific Microvasive) and OTSC clips.19 and 22 Moreover,

the application of endoclips for gaping defects was technically difficult and time-consuming and sometimes resulted in failure. These factors may explain the relatively high number of infectious adverse events in the endoclip group. Compared with endoclips, OP was associated with better clinical and histologic outcomes, including less intraperitoneal infection and adhesions, a shorter procedure time, fewer consumed clips, and more frequent complete wound healing. To the best of our knowledge, this is the first study to demonstrate the superiority of OP over endoclip alone for NOTES gastrotomy closure. Although the OP group had air leakage pressures and clip retention Amylase rates similar to the endoclip alone group, the incorporation of an omentum flap into gastric defects proved sufficient to protect the closure site from gastric spillage and hence facilitate the wound-healing process. It may lead to satisfactory clinical and histologic outcomes similar to closure with OTSC and the criterion standard hand-suturing closure. These favorable outcomes may be attributed to the superior healing properties of the omentum. The advantages of OP are widely recognized and extensively used for body defect repairs.

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