The Overstitch suturing device simulates free-hand suturing and allows controlled suture placement. The offset mucosal entry point was closed by interrupted polypropylene 3-0 sutures. Closure was considered adequate if the entry site was visibly closed without gaps and Sirolimus nmr there was sustained distention of the gastric lumen with air insufflation suggesting no air leak. The resected tissues were transported over ice to the laboratory in Ham F12 media (Invitrogen, Carlsbad, Calif). Resected tissue

was measured and sectioned. Hematoxylin and eosin staining was used to determine which muscle layers were included in the resected specimen, and an antibody to protein gene product 9.5 (PGP9.5) was used as a general neuronal marker to determine Cobimetinib purchase whether myenteric neurons were present in the sample.8 and 9 To study 12 animals, 14 pigs were enrolled. Two were excluded early in the study after 1 death caused by anesthesia-related complications and the other had a superficial mucosal tear over the tunnel. In the former, necropsy was performed and no abnormality was detected within the peritoneal cavity with an unremarkable postbiopsy site. In the latter, a muscularis propria resection was not performed, but the animal recovered well. In this setting, the procedure

could be hypothetically repeated after mucosal healing in 4 to 6 weeks. An FTGB was performed by using the SEMF technique in all 12 animals. The peritoneal cavity was visualized in each animal, providing endoscopic confirmation of a full-thickness resection (Fig. 2). The offset mucosal entry site was successfully closed in all animals by using the endoscopic suturing device (Fig. 3). No immediate procedure-related complications occurred. Histology showed muscularis propria and serosa, confirming full-thickness resections in all animals (Fig. 4). Multiple myenteric ganglia were visualized in 11 of 12 animals by using PGP9.5 antibodies (Fig. 5). In 1 animal, the snare slipped during resection, resulting in a smaller

sample that was full thickness but without identifiable myenteric ganglia. The mean total procedure time from submucosal injection to completion of suturing was 61 minutes (range 40-95 minutes). In the latter 6 animals, the resected tissues were measured before fixation with a recorded mean long-axis length of 11 mm (range ROS1 7-13 mm) (Fig. 6). Resections were performed from either the anterior or posterior gastric body. Two to 4 interrupted sutures were placed per animal. Procedure feasibility and safety did not differ with the use of rat-tooth grasping forceps (n = 6) versus a spiral tissue helix (n = 6) and a spiral snare (n = 6) versus hexagonal snare (n = 6). The clinical course was uneventful in all animals. Repeat endoscopy at 2 weeks showed stellate scarring at the mucosal entry sites and the absence of mucosal ulceration at the entry sites and overlying the more distal muscularis propria resection sites (Fig.