# Technical aspects of endoscopic internal drainage procedure, secured by endoscopic suture fixation: Experimental study

## TL;DR

This study tests a new endoscopic suturing tool to secure internal drains in the stomach, showing it can withstand significant force.

## Contribution

The study introduces and evaluates a novel endoscopic suturing device for securing internal drains in gastrointestinal fistulas.

## Key findings

- The new endoscopic suturing needle-holder SutuArt successfully fixed a drain at a gastric fistula site.
- The device withstood a pulling force of 6.7 Newtons, close to the reference full-thickness open-stitch value of 12 Newtons.
- The procedure was completed in a median time of 23 minutes, indicating practical potential for clinical use.

## Abstract

Techniques of interventional endoscopy such as implantation of stents, leak closure by clips, or endoscopic suturing can help in reducing risk of an unfavorable outcome for patients with fistulas in the gastrointestinal tract. One method is endoscopic internal drainage (EID), which has been reported to have remarkable success. Because dislocation can reduce success, endoscopic suture techniques have been applied; however, devices could be cumbersome and/or expensive. The purpose of this experimental study was to evaluation the new endoscopic suturing needle-holder SutuArt for fixation of internal drains at a gastric fistula site. This suturing system is a through-the-scope needle-holder, which can be rotated within the working channel 360 degrees and maneuvered with the endoscope tip in many positions. The experiment was performed using an explanted porcine stomach with attached esophagus. Three consecutive running stitches were performed to provide sufficient fixation of the drain at an experimental “fistula” site. Afterward, the force was measured to dislocate the fixed drain. The results of 12 measurements (median duration 23 minutes; range: 19–44) at 6.7 Newton were compared with the reference value of 12 Newton (full-thickness open-stitch), thus withstanding a substantial pulling force. In conclusion, this study demonstrates the conceptual possibility of using an endoscopic needle holder for suture-fixation of a drain. Further clinical investigations are required to establish a full feasibility test of the concept.