Endoscopic colotomy closure after full thickness excision: comparison of T fastener with multiclip applier

Background and study aims: Safe, reliable, and efficient endoscopic closure of a colotomy is paramount for endoscopic full thickness excision of the colon. Two newly developed devices, the Tissue Apposition System (TAS) and the InScope Multi-Clip Applier (IMCA), may help to achieve this. The aim of this study was to determine the feasibility of using each device to close colotomies after full thickness wall excisions.

Material and methods: 12 pigs were used in the study. After laparoscopic full thickness excision of the colonic wall, the defect was closed using either the TAS or the IMCA. Closure was performed under laparoscopic vision. Success of colotomy closure, time taken for colotomy closure, postoperative infections, and complication rates were recorded.

Results: Complete closure was achieved in 6/6 pigs in the TAS group. In 5/6 pigs in the IMCA group closure was successful; in one pig laparoscopic assistance was used. Median closure time (range) was significantly lower in the TAS group at 48 minutes (15 – 51) vs. 76 minutes (43 – 145) in the IMCA group. There were no postoperative infections or complications.

Conclusions: Endoscopic closure after full thickness colonic wall excision is feasible with both the TAS and the IMCA. Closure times are significantly shorter and handling is easier with the TAS. Combined use of both systems might be beneficial.

References

• 1 Winawer S J, Zauber A G, Ho M N. et al . Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup.  N Engl J Med. 1993;  329 1977-1981
• 2 Arebi N, Swain D, Suzuki N. et al . Endoscopic mucosal resection of 161 cases of large sessile or flat colorectal polyps.  Scand J Gastroenterol. 2007;  42 859-866
• 3 Zlatanic J, Waye J D, Kim P S. et al . Large sessile colonic adenomas: use of argon plasma coagulator to supplement piecemeal snare polypectomy.  Gastrointest Endosc. 1999;  49 731-735
• 4 Neugut A I, Johnsen C M, Forde K A, Treat M R. Recurrence rates for colorectal polyps.  Cancer. 1985;  55 1586-1589
• 5 Walsh R M, Ackroyd F W, Shellito P C. Endoscopic resection of large sessile colorectal polyps.  Gastrointest Endosc. 1992;  38 303-309
• 6 Saito Y, Uraoka T, Matsuda T. et al . Endoscopic treatment of large superficial colorectal tumors: a case series of 200 endoscopic submucosal dissections (with video).  Gastrointest Endosc. 2007;  66 966-973
• 7 Taku K, Sano Y, Fu K I. et al . Iatrogenic perforation associated with therapeutic colonoscopy: a multicenter study in Japan.  J Gastroenterol Hepatol. 2007;  22 1409-1414
• 8 Luning T H, Keemers-Gels M E, Barendregt W B. et al . Colonoscopic perforations: a review of 30,366 patients.  Surg Endosc. 2007;  21 994-997
• 9 Raju G S, Pham B, Xiao S Y. et al . A pilot study of endoscopic closure of colonic perforations with endoclips in a swine model.  Gastrointest Endosc. 2005;  62 791-795
• 10 Pham B V, Raju G S, Ahmed I. et al . Immediate endoscopic closure of colon perforation by using a prototype endoscopic suturing device: feasibility and outcome in a porcine model (with video).  Gastrointest Endosc. 2006;  64 113-119
• 11 Raju G S, Ahmed I, Brining D, Xiao S Y. Endoluminal closure of large perforations of colon with clips in a porcine model (with video).  Gastrointest Endosc. 2006;  64 640-646
• 12 Raju G S, Shibukawa G, Ahmed I. et al . Endoluminal suturing may overcome the limitations of clip closure of a gaping wide colon perforation (with videos).  Gastrointest Endosc. 2007;  65 906-911
• 13 Ikeda K, Fritscher-Ravens A, Mosse C A. et al . Endoscopic full-thickness resection with sutured closure in a porcine model.  Gastrointest Endosc. 2005;  62 122-129
• 14 Ikeda K, Mosse C A, Park P O. et al . Endoscopic full-thickness resection: circumferential cutting method.  Gastrointest Endosc. 2006;  64 82-89
• 15 Park P O, Bergstrom M, Ikeda K. et al . Experimental studies of transgastric gallbladder surgery: cholecystectomy and cholecystogastric anastomosis (videos).  Gastrointest Endosc. 2005;  61 601-606
• 16 Raju G S, Ahmed I, Shibukawa G. et al . Endoluminal clip closure of a circular full-thickness colon resection in a porcine model (with videos).  Gastrointest Endosc. 2007;  65 503-509