Necropsy after endoscopy showed complete healing of the serosa in all animals with minimal single-band adhesions in 5 of 12 animals (Fig. 8). Retained sutures were present in 10 of 12 animals. This preclinical survival study evaluated the technical feasibility, reproducibility, and safety of an FTGB by using the SEMF technique and endoscopic

suturing. By using this novel technique, a full-thickness biopsy of the entire muscularis propria that included oblique, circular, and longitudinal muscle layers could be technically achieved with sufficient tissue obtained from the intermuscular layer to identify multiple myenteric ganglia by using PGP9.5 antibodies. This is important because myenteric ganglia do not form a continuous layer, and therefore the sample needs to be sufficiently large to capture several ganglia. The significant benefit of the SEMF technique

is the presence of the overlying mucosal flap that serves as a safety Panobinostat chemical structure valve to seal the gastric wall perforation. Effective closure of the mucosal entry point was achieved in all animals by using the endoscopic suturing device. All 12 animals had an uncomplicated clinical course with complete healing of the mucosal and serosal aspects of the resection sites at follow-up endoscopy and necropsy. There was acquisition of ample tissue samples comparable to surgical specimens and in close accordance with the guidelines of the Gastro 2009 International Working Group on histological techniques.10 and 11 In human trials, the target site will be the anterior gastric Selleckchem Romidepsin body, approximately 9 cm proximal to the pylorus, as recommended by the guidelines

of the Gastro 2009 International Working Group.10 We anticipate that the resection technique, in theory, should be easier in a human study because of the improved endoscope position within the stomach compared with the near-retroflexed position of the endoscope when working in the porcine stomach. This procedure reflects an important directional shift in approaching invasive and complex endoscopic techniques. We previously reported on the evaluation of different existing endoscopic approaches for acquisition of deep biopsy samples of the gastric muscle wall to include the intermuscular layer. However, all of the 4-Aminobutyrate aminotransferase studied techniques including the innovative “no-hole” double EMR were limited by the lack of adequate tissue and/or safety.8 and 9 The no-hole EMR technique involved an initial gastric EMR followed by creating a pseudopolyp of the exposed muscularis propria by using endoloops and T-tag tissue anchors. The pseudopolyp was then resected. This study explored the concept of obtaining deep muscle wall biopsies by using a unique approach of resection without perforation. The SEMF technique was pioneered by research in our Developmental Endoscopy Unit as a concept to use the submucosa as an intramural working space for endoscopic interventions into or beyond the gut wall.