Endoscopic full-thickness resection and defect closure in the colon

Area of Science:

• Gastroenterology
• Minimally Invasive Surgery
• Endoscopy

Background:

• Endoscopic full-thickness resection (eFTR) offers a minimally invasive approach for en bloc resection of gastrointestinal lesions.
• Evaluating novel techniques for eFTR and defect closure is crucial for advancing endoscopic procedures.

Purpose of the Study:

• To assess the feasibility of a grasp-and-snare technique for eFTR in a porcine colon model.
• To compare the efficacy of over-the-scope clip (OTSC) closure versus endoloop ligation for defect closure after eFTR.

Main Methods:

• A nonsurvival study was conducted in a laboratory setting using fourteen female domestic pigs.
• eFTR was performed using a novel tissue anchor, monofilament snare, and 14 mm OTSC.
• Two groups were analyzed: Group 1 (n=20) utilized OTSC for defect closure; Group 2 (n=8) used an endoloop to secure the resection base prior to eFTR.

Main Results:

• In Group 1 (OTSC closure), successful defect closure was achieved in 9/20 cases with a mean burst pressure of 29.2 mm Hg. Complications included injury to adjacent organs (3 cases) and lumen obstruction (3 cases).
• In Group 2 (endoloop ligation), complete closure was achieved in all 8 cases with a mean burst pressure of 76.6 mm Hg. One case of lumen obstruction occurred. No other complications were observed.
• eFTR specimens in Group 1 ranged from 2.4-5.5 cm, while Group 2 specimens ranged from 1.2-2.2 cm.

Conclusions:

• The grasp-and-snare technique for colonic eFTR is feasible in an animal model.
• Pre-resection endoloop ligation of the resection base enhances closure success and reduces complications compared to OTSC alone, despite yielding smaller specimens.
• This technique shows promise for improving the safety and efficacy of endoscopic full-thickness resection.