# New technic to repair GI perforation with colonoscope



## SpAsMaN* (May 11, 2002)

Incisionless Suturing Possible for Closure of GI PerforationsMay 23, 2007 (Washington) - With a flexible endoscope, gastroenterologists and endoscopists can repair perforations, leaky anastomoses, and other breaches in the integrity of the gastrointestinal (GI) wall, anywhere along the GI tract that the scope can reach. The technique, called natural orifice transluminal endoscopic surgery (NOTES), allows clinicians to make incision-free repairs, eliminating the need for open surgery or even laparoscopy. Investigator Maria Bergstrom, MD, of the Department of Surgery at Sahlgrenska University Hospital in Gothenberg, Sweden, described NOTES and presented the results of a study on the technique at Digestive Disease Week (DDW).NOTES involves the use of a flexible endoscope to perform surgical procedures.Dr. Bergstrom described a technique for suturing that involves the insertion of metal tags through the endoscope, which are then anchored into the wall of the GI tract on either side of the area needing repair. Then, through the endoscope, the tags are sutured together.The procedure can be done under deep sedation rather than general anesthesia, she noted. The equipment is also portable, so that the procedure can be performed at the patient's bedside.Full gastric resection, pyloroplasty, and gastrojejunostomy are among the procedures that can be performed. The technique can also be used to repair leaky anastomoses from previous surgical interventions."Just this year we received [US Food and Drug Administration] approval to begin studies of the technique in humans," Dr. Bergstrom announced. "The first case was a 94-year-old woman who presented with what was thought to be pancreatitis, but turned out to be a perforated appendix. We removed the appendix [using NOTES], and the patient was sent home 9 days later." Her postoperative course was uneventful.Moderator Gregory Ginsberg, MD, AGAF, director of endoscopic services at the University of Pennsylvania in Philadelphia, told Medscape that "this is one of the most exciting developments being presented at this meeting.... There have been extensive animal studies and it really does represent a thoughtful evolution of a procedure.""This is an area that has generated a wellspring of activity," Dr. Ginsberg commented. "There has been a fairly unprecedented collegial spirit [among] endoscopists, gastroenterologists, and surgeons.... There has been a meeting of the minds in what he says "is an unusual collaboration between the specialties."DDW is jointly sponsored by 4 societies: the American Association for the Study of Liver Diseases, the American Gastroenterological Association, the American Society for Gastrointestinal Endoscopy, and the Society for Surgery of the Alimentary Tract.Neither Dr. Bergstrom nor Dr. Ginsberg report any relevant financial relationships.DDW 2007: Abstract 344. Presented May 22, 2007.


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