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

Abstract

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.