Antireflux operations at flexible endoscopy using endoluminal stitching techniques: an experimental study

Gastrointest Endosc. 1996 Aug;44(2):133-43. doi: 10.1016/s0016-5107(96)70130-x.


Background: Three antireflux operations-gastroplasty, fundoplication, and anterior gastropexy-were developed for performance at flexible endoscopy without laparotomy or laparoscopy.

Methods: An endoscopic sewing machine mounted on a standard gastroscope, endoscopic knotting devices, overtube, and nylon thread were used to perform these operations in adult beagle dogs.

Results: Gastroplasty (n = 10) was accomplished by suturing the anterior and posterior wall of the stomach to create a gastric tube (neoesophagus) along the lesser curve. An anatomic arrangement similar to fundoplication (n = 6) was achieved by invaginating the esophagus and fixing it to the stomach 2 cm distal to the cardioesophageal junction. Anterior gastropexy (n = 6) was performed using a technique similar to that used in creating percutaneous gastrostomies. There was no mortality. Ninety percent of sutures were seen at repeat endoscopy at 4 to 8 week intervals. The gastroplasty group was selected for more extensive evaluation. Manometry using a three-channel perfused catheter system before and after the procedures showed an increase in the lower esophageal sphincter pressure (preoperative median 4.6 mm Hg; post-operative median 13.33 mm Hg, p = 0.008) and cardiac yield pressures (preoperative median 10 mm Hg; postoperative median 19 mm Hg, p = 0.007).

Conclusions: This study demonstrates the feasibility of performing antireflux operations at flexible endoscopy, without laparoscopy or laparotomy, by use of endoluminal suturing techniques.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Dogs
  • Endoscopy / methods*
  • Esophagogastric Junction / physiopathology
  • Female
  • Fundoplication / instrumentation*
  • Gastroesophageal Reflux / physiopathology
  • Gastroesophageal Reflux / surgery*
  • Gastroplasty / instrumentation*
  • Gastroscopes
  • Humans
  • Manometry
  • Nylons
  • Pressure
  • Suture Techniques*


  • Nylons