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Endoscopic full-thickness resection and clip defect closure in the colon with the new FTRD system: experimental study

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Abstract

Background

The benefit of endoscopic full-thickness resection is the improved diagnostic work-up with an integral wall specimen which allows a precise determination of the tumor or its precursor and its infiltration depth into the wall.

Materials and methods

A new endoscopic full-thickness resection device (FTRD), which is a combination of a modified over-the-scope-clip (OTSC) system with an electrocautery snare, has been tested in an experimental setting. In eleven pigs, divided into three groups, endoscopic full-thickness resection was performed in the colon at one or two sites, respectively. Seven days (n = 7) or 28 days (n = 4) after the intervention, the animals were euthanized following endoscopic examination of the resection and clip application sites. Furthermore, two different clips were tested during these animal trials in order to evaluate the most effective clip design.

Results

The average diameter of the tissue resected with the FTRD was 3.1, 3.6, and 5.4 cm in the three groups. On follow-up endoscopy 7 days after the intervention, fibrin coating and stool residues were found at all clips, causing minor inflammatory reactions. However, the colon wall under the clip was non-inflamed. After 28 days, the serosa had primarily healed in all cases. There were also stool residues at all clips; however, no acute inflammatory reactions were seen anymore, due to complete healing. Histological assessment did not show any signs of dehiscence in the region of the scar, or ischemia in the clip area. In addition, no wound infections, such as abscess formation, were observed.

Conclusions

This study demonstrates the safety and efficacy of the clip-and-cut technique using the new FTRD system. With the device, a local full-thickness colon resection can be easily created, and the resulting wall defect is reliably sealed by the endoluminal application of a modified OTSC clip.

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Disclosures

Marc O. Schurr and Thomas Gottwald hold senior management positions for Ovesco Endoscopy AG. Franziska E. Baur is head of product manager of Ovesco Endoscopy AG. Manfred Wehrmann has no conflicts of interest or financial ties to disclose. Ruediger L. Prosst, Martina Krautwald, and Marion Fehlker are medical consultants of novineon CRO which advises Ovesco Endoscopy AG in regulatory and product development affairs.

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Authors and Affiliations

  1. Ovesco Endoscopy AG, Tübingen, Germany

    Marc O. Schurr, Franziska E. Baur & Thomas Gottwald

  2. Steinbeis Hochschule Berlin, Institute Healthcare Industries, Tübingen, Germany

    Marc O. Schurr

  3. Novineon CRO, Tübingen, Germany

    Martina Krautwald, Marion Fehlker & Ruediger L. Prosst

  4. Institute of Pathology, Nuertingen, Germany

    Manfred Wehrmann

  5. University of Tuebingen, Tübingen, Germany

    Thomas Gottwald

  6. Proctological Institute Stuttgart, Esslinger Str. 40, 70182, Stuttgart, Germany

    Ruediger L. Prosst

Authors
  1. Marc O. Schurr
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  2. Franziska E. Baur
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  3. Martina Krautwald
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  4. Marion Fehlker
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  5. Manfred Wehrmann
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  6. Thomas Gottwald
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  7. Ruediger L. Prosst
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Correspondence to Ruediger L. Prosst.

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Schurr, M.O., Baur, F.E., Krautwald, M. et al. Endoscopic full-thickness resection and clip defect closure in the colon with the new FTRD system: experimental study. Surg Endosc 29, 2434–2441 (2015). https://doi.org/10.1007/s00464-014-3923-x

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  • DOI: https://doi.org/10.1007/s00464-014-3923-x

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