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01-08-2015 | New Technology

Endoscopic full-thickness resection and clip defect closure in the colon with the new FTRD system: experimental study

Authors: Marc O. Schurr, Franziska E. Baur, Martina Krautwald, Marion Fehlker, Manfred Wehrmann, Thomas Gottwald, Ruediger L. Prosst

Published in: Surgical Endoscopy | Issue 8/2015

Abstract

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.

Hachisu T (1988) Evaluation of endoscopic hemostasis using an improved clipping apparatus. Surg Endosc 2(1):13–17PubMedCrossRef

Repici A, Arezzo A, De Caro G, Morino M, Pagano N, Rando G, Romeo F, Del Conte G, Danese S, Malesci A (2009) Clinical experience with a new endoscopic over-the-scope clip system for use in the GI tract. Dig Liver Dis 41(6):406–410PubMedCrossRef

Weiland T, Fehlker M, Gottwald T, Schurr MO (2013) Performance of the OTSC system in the endoscopic closure of iatrogenic gastrointestinal perforations: a systematic review. Surg Endosc 27(7):2258–2274PubMedCrossRef

Arezzo A, Verra M, Reddavid R, Cravero F, Bonino MA, Morino M (2012) Efficacy of the over-the-scope clip (OTSC) for treatment of colorectal postsurgical leaks and fistulas. Surg Endosc 26(11):3330–3333PubMedCrossRef

Saito Y, Fukuzawa M, Matsuda T, Fukunaga S, Sakamoto T, Uraoka T, Nakajima T, Ikehara H, Fu KI, Itoi T, Fujii T (2010) Clinical outcome of endoscopic submucosal dissection versus endoscopic mucosal resection of large colorectal tumors as determined by curative resection. Surg Endosc 24(2):343–352PubMedCrossRef

Brigic A, Symons NR, Faiz O, Fraser C, Clark SK, Kennedy RH (2013) A systematic review regarding the feasibility and safety of endoscopic full thickness resection (EFTR) for colonic lesions. Surg Endosc 27(10):3520–3529PubMedCrossRef

Schurr MO, Buess G, Raestrup H, Arezzo A, Buerkert A, Schell C, Adams R, Banik M (2001) Full thickness resection device (FTRD) for endoluminal removal of large bowel tumours: development of the instrument and related experimental studies. Minim Invasive Ther Allied Technol 10(6):301–309CrossRef

Rajan E, Gostout CJ, Burgart LJ, Leontovich ON, Knipschiel MA, Herman LJ, Norton ID (2002) First endoluminal system for transmural resection of colorectal tissue with a prototype full-thickness resection device in a porcine model. Gastrointest Endosc 55(7):915–920PubMedCrossRef

Agrawal D, Chak A, Champagne BJ, Marks JM, Delaney CP (2010) Endoscopic mucosal resection with full-thickness closure for difficult polyps: a prospective clinical trial. Gastrointest Endosc 71(6):1082–1088PubMedCrossRef

10.

Raju GS, Malhotra A, Ahmed I (2009) Colonoscopic full-thickness resection of the colon in a porcine model as a prelude to endoscopic surgery of difficult colon polyps: a novel technique. Gastrointest Endosc 70(1):159–165PubMedCrossRef

11.

Sandmann M, Heike M, Faehndrich M (2011) Application of the OTSC system for the closure of fistulas, anastomosal leakages and perforations within the gastrointestinal tract. Z Gastroenterol 49(8):981–985PubMedCrossRef

12.

Picasso M, Parodi A, Fisher DA, Blanchi S, Conio M (2013) Full thickness endoscopic resection of a colonic cancer: a case report. Clin Res Hepatol Gastroenterol 37(4):e99–e101PubMedCrossRef

13.

Mönkemüller K, Peter S, Toshniwal J, Popa D, Zabielski M, Stahl RD, Ramesh J, Wilcox CM (2014) Multipurpose use of the ‘bear claw’ (over-the-scope-clip system) to treat endoluminal gastrointestinal disorders. Dig Endosc 26(3):350–357PubMedCrossRef

14.

Schlag C, Wilhelm D, von Delius S, Feussner H, Meining A (2013) EndoResect study: endoscopic full-thickness resection of gastric subepithelial tumors. Endoscopy 45(1):4–11PubMed

15.

von Renteln D, Kratt T, Rösch T, Denzer UW, Schachschal G (2011) Endoscopic full-thickness resection in the colon by using a clip-and-cut technique: an animal study. Gastrointest Endosc 74(5):1108–1114CrossRef

16.

Hope WW, Zerey M, Schmelzer TM, Newcomb WL, Paton BL, Heath JJ, Peindl RD, Norton HJ, Lincourt AE, Heniford BT, Gersin KS (2009) A comparison of gastrojejunal anastomoses with or without buttressing in a porcine model. Surg Endosc 23(4):800–807PubMedCrossRef

17.

Nandakumar G, Richards BG, Trencheva K, Dakin G (2010) Surgical adhesive increases burst pressure and seals leaks in stapled gastrojejunostomy. Surg Obes Relat Dis 6(5):498–501PubMedCrossRef

Title: Endoscopic full-thickness resection and clip defect closure in the colon with the new FTRD system: experimental study
Authors: Marc O. Schurr
Franziska E. Baur
Martina Krautwald
Marion Fehlker
Manfred Wehrmann
Thomas Gottwald
Ruediger L. Prosst
Publication date: 01-08-2015
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 8/2015
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-014-3923-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Endoscopic full-thickness resection and clip defect closure in the colon with the new FTRD system: experimental study

Abstract

Background

Materials and methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Materials and methods

Results

Conclusions

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