An experienced therapeutic Endoscopist and First Assistant, both who have attended a Bard EndoCinch* Suturing System Training workshop.
Anesthesiologist or Anesthetist/CRNA (or dedicated RN for IVCS)
Circulating Nurse.
Equipment Required:
Two video endoscopes
Esophageal overtube
Bard EndoCinch* 2 Suturing System
Pharmacy Requirements:
Sedative, such as IV narcotics with benzodiazapine or IV Propofol.
Anti-emetics, such as Reglan or Compazine.
Throat anesthetizing agents, such as Lidocaine.
Procedural Steps of ELGP:
ELGP is typically performed using deep sedation (intravenous narcotics, benzodiazepines).
Two endoscopes are required. One is dedicated to the Bard EndoCinch* 2 Suturing System, while the other is used to create the plications and cut the surgical thread.
Procedure begins with a diagnostic endoscopy to confirm pre-procedure endoscopic findings.
An esophageal overtube is placed over an esophageal dilator. Dilator is removed and the overtube is left in place for the multiple endoscopic passes needed to create each plication.
With a second endoscope, the gastroenterologist advances the EndoCinch* 2 Suturing device to approximately 1-2 cm below the squamocolumnar junction.
By application of 10-20 second wall suction, a fold of tissue is suctioned into the EndoCinch* capsule chamber. The device handle is actuated and a needle is advanced through the tissue bite. The device's pusher wire is then advanced through the needle, pushing the tag and suture through the tissue to place the first stitch through the suctioned tissue.
Vacuum is turned off & the EndoCinch* device handle is retracted, releasing the tissue. The tag remains captured in the distal end cap. The scope is withdrawn to pull the suture through the tissue.
The suture is reloaded into the needle and the endoscope is reinserted to the stitch location.
A second stitch is placed at a location 1 cm adjacent to the first stitch.
After both stitches have been placed, the system is again withdrawn. The endoscope with the suture anchor system is used to finally create a plication.
The suture anchor system is advanced to the stitch location. By actuation of the anchor system handle, a suture anchor cinches the two ends of the suture together. Further actuation of the handle cuts the excess suture approximately cm in length from the plication.
The procedure is then repeated until all desired placations are created. Physicians report the majority of patients require two placations.
If a third plication is warranted, the process is repeated a third time.
After all plications have been created, the EndoCinch* Suturing System and overtube are removed.
To complete the procedure, an endoscope is reinserted to compare pre-procedural and post-procedural tone of the Lower Esophageal Sphincter (Figure #1 & 2).
Figure 1: Pre Procedural LES Appearance
Figure 2: Post Procedural LES Appearance
Post-Procedure:
The patient is transferred to Recovery Room and discharged home the same day to resume activities of daily living the next day.
Transient side effects of the procedure may include: sore throat, transient dysphasia, nausea secondary to sedation, and abdominal bloating/pain secondary to insuflation.
One week post-procedure, the patient returns to the physician's office.
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