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. 2019 Jul;92(1099):20180837.
doi: 10.1259/bjr.20180837. Epub 2019 May 31.

The application of a vascular closure device for closing a gastrostomy opening used for procedural access

Sung Bum Cho  1 , Hyoung Rae Kim  2 , Eui-Chul Jung  3 , Hwan Hoon Chung  4 , Seung Hwa Lee  4 , Beom Jin Park  1 , Deuk Jae Sung  1
Affiliations

The application of a vascular closure device for closing a gastrostomy opening used for procedural access

Sung Bum Cho et al. Br J Radiol. 2019 Jul.

Abstract

Objective: To study the feasibility of applying the Perclose ProGlide vascular closure device (PPVCD) in vitro for closing a gastrostomy opening for procedural access in the swine stomach in order to prevent peritoneal leakage.

Methods: The study included four experimental groups: one manual suture (n = 10), two manual sutures (n = 10), one PPVCD suture (n = 10), and two PPVCD sutures (n = 5). In the two PPVCD sutures group, the "pre-close" technique was used. The leak pressure was measured, and statistical analysis was conducted to compare the leak pressures among the experimental groups.

Results: The gastrostomy openings were successfully closed in all experimental groups. The median (range) values of leak pressure (mmHg) for each experimental group were as follows: one manual suture, 86.0 (75.0-110.0); two manual sutures, 98.5 (44.0-130.0); one PPVCD suture, 96.5 (56.0-119.0); and two PPVCD sutures, 98.0 (66.0-104.0). The Mann-Whitney U test revealed no statistically significant difference in leak pressure between the manual (n = 20) and PPVCD (n = 15) suture groups. The Kruskal-Wallis test revealed no statistically significant difference in leak pressure among the four experimental groups. The Bonferroni post hoc test also revealed no statistically significant difference in the pairwise comparisons among the groups.

Conclusion: Application of PPVCD is feasible for the closure of gastrostomy openings in an animal model and is as effective as a manual suture.

Advances in knowledge: In our in vitro study, percutaneous closure of gastrostomy opening using PPVCD was possible; animal survival studies and development of specific devices are needed before clinical application.

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Figures

Figure 1.
Figure 1.
Preparation of the swine stomach. (a) The excised swine stomach was fixed on an acrylic plate, and the stomach openings were sealed using long Kelly forceps with two metal tubes (white arrows) inserted through the esophagus. (b) The tip of one metal tube was positioned near the esophageal orifice (black arrow) for infusing air into the stomach. Another metal tube was used to measure the intragastric pressure, and the tip was placed close to the opposite wall (white arrow) to eliminate the influence of dynamic pressure.
Figure 2.
Figure 2.
Perclose ProGlide. (a) Names of components are shown. (b) The lever of the device was lifted and the feet were deployed. (c) The needle plunger was depressed to deploy the needles through polystyrene plate and into the feet. (d) Two needles penetrated the gastric wall and captured the pre-knotted sutures at the feet of the PPVCD. PPVCD, Perclose ProGlide vascular closure device.
Figure 3.
Figure 3.
Two PPVCD sutures with the pre-close technique. (a) After the first PPVCD was inserted and rotated about 30° counterclockwise, the first suture loop was formed, which was not tied and held using a small clamp (arrow). The second device was inserted with a 30° clockwise rotation. (b) The second suture loop was also held using a second clamp without tying. The gastrostomy openings were sequentially dilated to 18 F. (c) The knot of the first suture loop was tied first followed by that of the second suture loop to complete the closure of the gastrostomy opening. PPVCD, Perclose ProGlide vascular closure device.
Figure 4.
Figure 4.
The measurement of leak pressure via the identification of soap bubbles.
Figure 5.
Figure 5.
Partial-thickness suture. The knot is buried in the incision.
See this image and copyright information in PMC

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