In vivo assessment of a biological occluder for notes gastrotomy closure

Alejandro F. Sanz, Toshitaka Hoppo, Bart P. Witteman, Bryan N. Brown, Thomas W. Gilbert, Stephen F. Badylak, Blair A. Jobe, Alejandro Nieponice*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: The objective of this study is to evaluate the closure of a transgastric natural orifice transluminal endoscopic surgery (NOTES) access using a multilayer extracellular matrix (ECM) occluder in a canine model. Materials And Methods: Mongrel dogs (n=4) underwent a transgastric NOTES peritoneoscopy and the gastrotomy was closed by deploying a 2-sided ECM occluder. Animals were killed at 7 days (n=2) and 8 weeks (n=2) for macroscopic and microscopic assessment. Results: All procedures were completed without any complications. No air leaks were detected immediately after the procedure and at 48 hours postoperatively. At 7 days, ECM appeared to be resolved and mild mucosal inflammation was found at the site of gastrotomy. At 8 weeks, the gastrotomy site was macroscopically and microscopically covered with a normal-appearing gastric mucosa. There was an absence of inflammatory cells and no evidence of the ECM. Conclusion: The ECM occluder is safe and effective in this "proof-of-concept" preclinical model.

Original languageEnglish
Pages (from-to)322-326
Number of pages5
JournalSurgical Laparoscopy, Endoscopy and Percutaneous Techniques
Issue number4
StatePublished - Aug 2014
Externally publishedYes


  • Canine model
  • Gastrotomy
  • Inflammatory cells
  • Multilayer extracellular matrix accluder
  • Notes
  • Peritoneoscopy


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