Endoscopic sleeve gastroplasty (ESG) is expected to be a less invasive treatment for obesity. We consider that endoscopic hand suturing (EHS) should be applicable to this procedure. We aimed to investigate the feasibility and safety of “Handsewn ESG” in animal models.

Handsewn ESG was performed on eight animal stomachs (four isolated porcine stomachs, two live pigs, and two live dogs). In vivo studies were conducted after the approval of respective Institutional Review Boards. Twelve mucosal defects per stomach were created: four lesions on the anterior wall, greater curvature, and posterior wall, respectively. Continuous suturing was performed for the respective distal and proximal six mucosal defects in a rectangular shape with a 2-0 barbed suture (VLOCN0605 or VLOCL0615). Immediately after the procedure was completed, the live pigs were humanely euthanized, and their stomachs were removed for macroscopic examination. The live dogs were monitored for two months after the procedure, followed by endoscopic observation. Short-term outcomes (all eight cases), a gastric volume reduction rate and a full-thickness suturing rate (six cases), adverse events (four live animals), food intake, changes in body weight, and a closure maintenance rate at two months post the procedure (two live dogs) were investigated.

The procedure was completed in all cases (8/8, 100%), and the average procedure time was 130.8 minutes. In six cases excluding live dogs, the average gastric volume reduction rate was 25.7%. Among four cases (48 suture sites) in which suture status was observed, 24 sites (50%) revealed full-thickness suturing. No adverse events were occurred in live animals (0%, 0/4), whereas in one sacrificed pig, one stitch hooked part of small intestinal serosa. Both live dogs’ food intake had decreased for three days following EHS, but recovered to normal intake after the fourth postoperative day. At the second postoperative month, endoscopic observation revealed that the stomach reverted with disappearance of the suture in both cases.

We confirmed Handsewn EHS is technically feasible. On the other hand, further improvement and refinement are necessary to elevate it to a safe and reliable procedure.