Endoscopic full-thickness resection in the colon by using a clip-and-cut technique: an animal study.

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.