Study of full-thickness endoluminal segmental resection of colon in a porcine colon model (with videos)

Abstract

Background: Entrapment injury of the adjacent bowel is frequently encountered during full-thickness endoluminal colon suction-resection.

Objective: Our purpose was to develop a technique that can create a full-thickness resection of the colon without the risk of entrapment injury to adjacent viscera.

Design: Pilot study.

Setting: University medical center.

Patients: Five pigs.

Interventions: Traction-resection of the colon was created by using a grasping forceps to pull the colon into a band ligator loaded on a double-channel endoscope, followed by the application of a band, and subsequent snare resection (n = 14). Suction-resection of the colon was created by using a double-channel endoscope loaded with a band ligator (n = 12) and a single-channel endoscope with a band ligator (n = 6).

Main outcome measurements: Number of full-thickness colon resections, frequency of the adjacent bowel and mesenteric injury, and the size of the resections were measured.

Results: The suction-resection technique resulted in significant injury to adjacent viscera compared with the traction-resection technique (56% vs 0%, P = .0013). The traction-resection method resulted in a significantly larger resection compared with the suction-resection method (mean +/- SEM: 2.91 +/- 0.3 cm vs 2.1 +/- 0.1 cm, P = .024). A double-channel endoscope suction-resection method resulted in a significantly larger resection compared with a single channel suction-resection technique (mean +/- SEM: 2.1 +/- 0.1 cm vs 0.91 +/- 0.2 cm, P = .0022).

Limitations: None.

Conclusions: The traction-resection technique is safer than the suction-resection method in removing larger specimens of the colon. In addition, the traction-resection technique reduces the risk of injury of the mesentery or adjacent small intestine.