BACKGROUND: The benefit of endoscopic full-thickness resection is the improved diagnostic work-up with an integral wall specimen which allows a precise determination of the tumor or its precursor and its infiltration depth into the wall. MATERIALS AND METHODS: A new endoscopic full-thickness resection device (FTRD), which is a combination of a modified over-the-scope-clip (OTSC) system with an electrocautery snare, has been tested in an experimental setting. In eleven pigs, divided into three groups, endoscopic full-thickness resection was performed in the colon at one or two sites, respectively. Seven days (n = 7) or 28 days (n = 4) after the intervention, the animals were euthanized following endoscopic examination of the resection and clip application sites. Furthermore, two different clips were tested during these animal trials in order to evaluate the most effective clip design. RESULTS: The average diameter of the tissue resected with the FTRD was 3.1, 3.6, and 5.4 cm in the three groups. On follow-up endoscopy 7 days after the intervention, fibrin coating and stool residues were found at all clips, causing minor inflammatory reactions. However, the colon wall under the clip was non-inflamed. After 28 days, the serosa had primarily healed in all cases. There were also stool residues at all clips; however, no acute inflammatory reactions were seen anymore, due to complete healing. Histological assessment did not show any signs of dehiscence in the region of the scar, or ischemia in the clip area. In addition, no wound infections, such as abscess formation, were observed. CONCLUSIONS: This study demonstrates the safety and efficacy of the clip-and-cut technique using the new FTRD system. With the device, a local full-thickness colon resection can be easily created, and the resulting wall defect is reliably sealed by the endoluminal application of a modified OTSC clip.
BACKGROUND: The benefit of endoscopic full-thickness resection is the improved diagnostic work-up with an integral wall specimen which allows a precise determination of the tumor or its precursor and its infiltration depth into the wall. MATERIALS AND METHODS: A new endoscopic full-thickness resection device (FTRD), which is a combination of a modified over-the-scope-clip (OTSC) system with an electrocautery snare, has been tested in an experimental setting. In eleven pigs, divided into three groups, endoscopic full-thickness resection was performed in the colon at one or two sites, respectively. Seven days (n = 7) or 28 days (n = 4) after the intervention, the animals were euthanized following endoscopic examination of the resection and clip application sites. Furthermore, two different clips were tested during these animal trials in order to evaluate the most effective clip design. RESULTS: The average diameter of the tissue resected with the FTRD was 3.1, 3.6, and 5.4 cm in the three groups. On follow-up endoscopy 7 days after the intervention, fibrin coating and stool residues were found at all clips, causing minor inflammatory reactions. However, the colon wall under the clip was non-inflamed. After 28 days, the serosa had primarily healed in all cases. There were also stool residues at all clips; however, no acute inflammatory reactions were seen anymore, due to complete healing. Histological assessment did not show any signs of dehiscence in the region of the scar, or ischemia in the clip area. In addition, no wound infections, such as abscess formation, were observed. CONCLUSIONS: This study demonstrates the safety and efficacy of the clip-and-cut technique using the new FTRD system. With the device, a local full-thickness colon resection can be easily created, and the resulting wall defect is reliably sealed by the endoluminal application of a modified OTSC clip.
Authors: Elizabeth Rajan; Christopher J Gostout; Lawrence J Burgart; Olga N Leontovich; Mary A Knipschiel; Lori J Herman; Ian D Norton Journal: Gastrointest Endosc Date: 2002-06 Impact factor: 9.427
Authors: Daniel von Renteln; Thomas Kratt; Thomas Rösch; Ulrike W Denzer; Guido Schachschal Journal: Gastrointest Endosc Date: 2011-09-23 Impact factor: 9.427
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: A Repici; A Arezzo; G De Caro; M Morino; N Pagano; G Rando; F Romeo; G Del Conte; S Danese; A Malesci Journal: Dig Liver Dis Date: 2008-10-18 Impact factor: 4.088
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