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ECHELON FLEX™ GST System - the next evolution in stapling

Ethicon launches new stapling innovation with Advanced Gripping Surface Technology
GST System is now available in Europe and the Middle East

In February, Ethicon announced the launch of the ECHELON FLEX™ GST System, a new powered stapler and reload system uniquely designed to provide a better grip on tissue(1) for the least tissue slippage during firing.(2)

Tissue movement or slippage during firing can result in poorly formed and spaced staples as well as the need for extra firings to complete the intended tissue transection.  Through proprietary Reloads with Gripping Surface Technology (GST), the ECHELON FLEX™ GST System offers a more secure hold on tissue(1) to deliver at least 56% less tissue slippage during firing(2) for more targeted tissue transections(3) and the potential to eliminate one reload per procedure(2) - providing enhanced economic value.  By reducing the amount and impact of tissue slippage, reliable staple formation extends across a range of tissue thicknesses in each reload.(4)

“Surgeons have long needed a stapling solution that enables reliable performance and staple line security without risk of additional tissue trauma, particularly in bariatric surgery procedures such as sleeve gastrectomy, where they may encounter an unexpected variance in tissue thickness”, said Dr. Elliott Fegelman, Senior Medical Director at Ethicon.  “The exciting aspect of the ECHELON FLEX™ GST System is that you now have optimal compression integrated with better grasping during the firing sequence. This means consistent staple formation, which may help reduce the risk of a leak or bleeding across a broad range of tissue thicknesses thereby reducing the potential for complications.”

The ECHELON FLEX™ GST System is the latest offering in Ethicon’s ECHELON FLEX™ Line of Powered Endocutters.  Built on the stability of a powered firing, the platform provides 88% less movement at the end effector(5) and potentially less trauma to adjacent tissue.

“The tissue does not move visibly and this gives me much more confidence and precision”, said Dr. Bruno Dillemans, Consultant General, Laparoscopic, and Bariatric Surgeon at St. Jans Hospital, Brugge, Belgium, during one of the first European cases using the ECHELON FLEX™ GST System.  Dr. Dillemans also commented: “The device delivers a high quality of staple linesand I needed to use fewer clips.”

Following a European launch, the ECHELON FLEX™ GST System is now also available in the Middle East with initial cases taking place in Doha, Qatar and Dubai, UAE. 

Surgeon feedback from the Middle East indicates that the ECHELON FLEX™ GST System has clear advantages in terms of delivering precision and stability, with significantly less tissue movement and good hemostasis. There is great interest to see how this translates into patient outcomes.(6)

The ECHELON FLEX™ GST System includes the ECHELON FLEX™ Powered Plus Stapler and the ENDOPATH ECHELON™ Reloads with Gripping Surface Technology. It is designed for bariatric, abdominal and thoracic procedures.


  • At least 56% less tissue slippage during firing compared to Endo GIA™ Reloads with Tri-Staple™ technology for unsurpassed staple performance(2)
    - May eliminate 1 reload per procedure due to less tissue slippage during firing(2)
    - Delivers a more targeted tissue transection with each firing(3)
  • Only system that provides uniform closed staple height for exceptional staple line integrity now across a range of tissue thicknesses with each reload(4)
  • Exclusive reloads with Gripping Surface Technology, offering a proprietary ridged surface to provide an atraumatic grip that holds tissue in place during firing.(7)

Learn more at, and follow Ethicon on Twitter @Ethicon.


  1. Benchtop testing in porcine stomach tissue. Mean peak load required to pull tissue from the clamped jaws of ECHELON FLEX Powered Plus Stapler (PSEE60A) and ECHELON Reload with GST vs ENDO GIA ULTRA Handle (EGIAUSTND) and Endo GIA Reload with Tri-Staple Technology (GST60B 6.496lbf & GST60T 7.789lbf vs EGIA60AMT 1.325lbf & EGIA60AXT 1.920lbf, all p<0.001).
  2. Benchtop testing in porcine stomach tissue. Mean tissue movement from after clamping on tissue to after firing ECHELON FLEX Powered Plus Stapler (PSEE60A) and ECHELON Reload with GST vs ENDO GIA™ ULTRA Handle (EGIAUSTND) and Endo GIA™ Reload with Tri-Staple™ Technology at 1.5, 2.5, 3.3 and 4.0mm tissue thicknesses (1.5mm; GST60B 1.067mm vs EGIA60AMT 2.452mm p<0.001; 2.5mm: GST60G 1.148mm vs EGIA60AMT 3.261mm p<0.001; 3.3mm: GST60T 0.642mm vs EGIA60AMT 4.806mm p<0.001; 4.0mm: GST60T 0.654mm vs EGIA60AXT 5.116mm p<0.001).
  3. Benchtop testing in porcine stomach tissue.   Mean tissue movement from before clamping on tissue to release of tissue after firing ECHELON FLEX™ Powered Plus Stapler (PSEE60A) and ECHELON Reload with GST vs ENDO GIA™ ULTRA Handle (EGIAUSTND) and Endo GIA™  Reload with Tri-Staple™ Technology at 1.5, 2.5, 3.3 and 4.0mm tissue thicknesses (1.5mm; GST60B 2.835mm vs EGIA60AMT 2.369mm NS; 2.5mm: GST60G 2.864mm vs EGIA60AMT 3.273mm p<0.001; 3.3mm: GST60T 0.897mm vs EGIA60AMT 6.814mm p<0.001; 4.0mm: GST60T 1.415mm vs EGIA60AXT 4.616mm p<0.001).
  4. Porcine tissue thickness measured at 8g/mm2 prior to firing.  Tissue comfortably compressed to closed staple height per IFU.
  5. Benchtop testing on porcine stomach tissue. Surgeons (n=19) fired each instrument/ reload once: PSE60A/ ECR60G, 030449/ 030459, and EGIAUSTND/ EGIA60AMT. Median reduction of distal tip motion was 88%, range of reduction was 71% to 95%.
  6. Information is based on feedback from Dr. Mohammed Alkuwari, Bariatric and Metabolic Surgery Consultant, Hamad Medical Corporation, Doha, Qatar.
  7. Based on 10-15 second clamp and release testing on animate preclinical lung and vasculature. Visual comparisons of 40 paired clampings immediately following, and at 1hr after clamping.

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Please refer always to the Instructions for Use/Package Insert that come with the device for the most current and complete instructions.


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