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CC BY 4.0 · Endoscopy 2023; 55(S 01): E821-E822
DOI: 10.1055/a-2085-0199
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Coloenterostomy performed endoscopically using through-the-scope twin clips in a porcine model

Qiang Zhang 
Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
,
Zhen Wang
Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
,
Chudi Chen
Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
,
Side Liu
Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
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A novel through-the-scope twin clip or dual action tissue closure device (TTS-TC or DAT Closure Device; Micro-Tech Co. Ltd., Nanjing, China) was first reported by us [1] [2]. We have previously performed endoscopic gastric bypass using TTS-TCs in a live pig [3]. We have now for the first time performed coloenterostomy, similarly to colonic–small intestinal bypass, in a live pig. The operation steps are shown in [Video 1].

Video 1 The colon, approximately 20 cm away from the anus, is anastomosed to the small intestine using through-the-scope twin clips to create an endoscopic coloenterostomy in a live pig.


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First, in the colon approximately 20 cm away from the anus, a colonic opening was made into the abdominal cavity (opening 1) using endoscopic full-thickness resection ([Fig. 1 a]). Next, a TTS-TC was delivered into the abdominal cavity through the endoscope working channel, and the small intestinal wall was clamped using one side of the TTS-TC. The clamped intestine was pulled through opening 1 into the colon using the TTS-TC, then the colonic mucosa was clamped using the other side of the TTS-TC to anchor the intestine that had been pulled through into the colon ([Fig. 1 b]). A longitudinal opening (opening 2) was then made in the small intestine anchored in the colon ([Fig. 1 c]). The intestinal wall at the edge of opening 2 was clamped using one side of another TTS-TC and pulled close to the colon at opening 1, before openings 1 and 2 were clamped together using the other side of the TTS-TC ([Fig. 1 d]). Further TTS-TCs were used to continue joining openings 1 and 2, then traditional TTS clips were used to close the remaining wound. A total of nine TTS-TCs and 12 TTS clips were used. The total operation time was 75 minutes. Cephalosporins were administered intramuscularly for 1 week postoperatively.

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Fig. 1 The steps in creation of an endoscopic coloenterostomy, anastomosing the colon approximately 20 cm away from the anus to the small intestine, were: a creation of opening 1 in the colonic wall by endoscopic full-thickness resection; b clamping of the small intestinal wall with one clip of a through-the-scope twin clip (TTS-TC), which was then pulled into the colonic lumen where it was anchored using the second clip of the TTS-TC; c creation of opening 2 in the small intestinal wall; d clamping together of the intestinal walls at the edges of openings 1 and 2 using further TTS-TCs; e successful creation of the coloenterostomy with good healing of the wound 2 months postoperatively.

At 2-month follow-up, no perforation or bleeding had occurred, the wound was healed and the TTS-TCs had fallen off spontaneously. The coloenterostomy had been successfully created ([Fig. 1 e]); however, further study is needed to optimize the procedure and evaluate its safety and feasibility.

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Publication History

Article published online:
22 June 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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