BACKGROUND: Although endoscopic resection techniques have been established for definitive therapy of mucosal neoplasia, complete histopathological assessment or resection of subepithelial lesions is not reliably possible. OBJECTIVE: To overcome these limitations, a novel endoscopic full-thickness resection (EFTR) and closure technique was developed. DESIGN: Animal survival study. ANIMALS: Eight female domestic pigs. INTERVENTIONS: Two-centimeter artificial distal colonic lesions were created endoscopically. EFTR of the lesions was attempted using a prototype device, which consists of a large transparent plastic cap with a preloaded snare and a modified over-the-scope clip. After the procedure, half of the animals were killed after 7 days, and the other half after 28 days. MAIN OUTCOME MEASUREMENTS: Complete resection (all markings included in the specimen), technical success, complication rates, and wound healing on follow-up autopsy and histology. RESULTS: EFTR of healthy colonic tissue was possible in all cases; 2 additional clips had to be placed for complete closure in 1 case. In 1 animal, the preloaded closure failed, and the animal was prematurely killed. All other animals had an uneventful postoperative course. Necropsy and histopathological evaluation demonstrated well-healed resection sites with no evidence of intra-abdominal infection or inadvertent organ inclusion. LIMITATIONS: Animal model, resection of healthy tissue. CONCLUSION: This novel device allows for reliable full-thickness resection and closure of 2-cm specimens of the colonic wall in a single procedure as well as reliable wound healing of EFTR defects.
BACKGROUND: Although endoscopic resection techniques have been established for definitive therapy of mucosal neoplasia, complete histopathological assessment or resection of subepithelial lesions is not reliably possible. OBJECTIVE: To overcome these limitations, a novel endoscopic full-thickness resection (EFTR) and closure technique was developed. DESIGN: Animal survival study. ANIMALS: Eight female domestic pigs. INTERVENTIONS: Two-centimeter artificial distal colonic lesions were created endoscopically. EFTR of the lesions was attempted using a prototype device, which consists of a large transparent plastic cap with a preloaded snare and a modified over-the-scope clip. After the procedure, half of the animals were killed after 7 days, and the other half after 28 days. MAIN OUTCOME MEASUREMENTS: Complete resection (all markings included in the specimen), technical success, complication rates, and wound healing on follow-up autopsy and histology. RESULTS: EFTR of healthy colonic tissue was possible in all cases; 2 additional clips had to be placed for complete closure in 1 case. In 1 animal, the preloaded closure failed, and the animal was prematurely killed. All other animals had an uneventful postoperative course. Necropsy and histopathological evaluation demonstrated well-healed resection sites with no evidence of intra-abdominal infection or inadvertent organ inclusion. LIMITATIONS: Animal model, resection of healthy tissue. CONCLUSION: This novel device allows for reliable full-thickness resection and closure of 2-cm specimens of the colonic wall in a single procedure as well as reliable wound healing of EFTR defects.
Authors: Marc O Schurr; Franziska E Baur; Martina Krautwald; Marion Fehlker; Manfred Wehrmann; Thomas Gottwald; Ruediger L Prosst Journal: Surg Endosc Date: 2014-10-16 Impact factor: 4.584
Authors: Adela Brigic; Nicholas R A Symons; Omar Faiz; Chris Fraser; Susan K Clark; Robin H Kennedy Journal: Surg Endosc Date: 2013-04-16 Impact factor: 4.584
Authors: Irmengard Krutzenbichler; Markus Dollhopf; Helmut Diepolder; Andreas Eigler; Martin Fuchs; Simon Herrmann; Gerhard Kleber; Björn Lewerenz; Christoph Kaiser; Tilman Lilje; Timo Rath; Ayman Agha; Francesco Vitali; Claus Schäfer; Wolfgang Schepp; Felix Gundling Journal: Surg Endosc Date: 2020-07-09 Impact factor: 4.584
Authors: Patrick Aepli; Dominique Criblez; Stephan Baumeler; Jan Borovicka; Remus Frei Journal: United European Gastroenterol J Date: 2017-08-23 Impact factor: 4.623