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Published on: November 24, 2014
Comparing over-the-scope clip versus endoloop and clips (KING closure) for access site closure: a randomized
J Martínek1, O Ryska, I Tuckova
1Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Videnska 1958, 140 21, Prague 4, Czech Republic. jan.martinek@volny.cz
Surgical Endoscopy
|October 18, 2012
Summary
KING closure demonstrated superior histological healing compared to over-the-scope clips (OTSC) for Natural Orifice Translumenal Endoscopic Surgery (NOTES) access site closure, though both techniques were comparable in feasibility and effectiveness.
Area of Science:
- Gastroenterology and Endoscopy
- Surgical Innovation
- Minimally Invasive Procedures
Background:
- Safe and effective closure techniques are critical for Natural Orifice Translumenal Endoscopic Surgery (NOTES) and iatrogenic perforation repair.
- Current methods require evaluation for optimal patient outcomes and healing.
Purpose of the Study:
- To compare the efficacy and histological outcomes of over-the-scope clip (OTSC) versus a combined endoloop and endoclips technique (KING closure).
- To assess technical feasibility, effectiveness, and healing characteristics of both closure methods.
Main Methods:
- A comparative study involving 40 minipigs undergoing NOTES peritoneoscopy with liver biopsy.
- Gastrotomies and rectotomies were created and closed using either OTSC (n=20) or KING closure (n=20).
- Animals were observed for 28 days post-procedure to evaluate healing and complications.
Main Results:
- Both OTSC and KING closure were technically feasible and effective, with similar closure times.
- Histological analysis revealed significantly better transmural healing with muscular bridging in the KING closure group for both stomach and rectum (p=0.003).
- The OTSC group showed a trend towards increased inflammation (p=0.08 for stomach, p=0.03 for rectum) and experienced one case of enterocolic fistula.
Conclusions:
- Over-the-scope clip (OTSC) and KING closure are comparable in terms of technical success and immediate effectiveness for NOTES access sites.
- KING closure offers superior histological healing outcomes, characterized by enhanced transmural healing and muscular bridging, compared to OTSC.
