Endoscopic full-thickness resection in the colon using a clip and cut technique

Background: While endoscopic resection techniques have been established for definitive therapy of mucosal neoplasia, complete resection of deeper and subepithelial lesions is not reliably possible. To overcome these limitations a novel endoscopic full-thickness resection (EFTR) and closure technique was developed.

Methods: in eight anesthetized female domestic pigs 2cm artificial colonic lesions were created endoscopically by circumferential electrocautery markings. EFTR of the lesions was attempted using a prototype device, which consists of a large transparent plastic cap with a pre-loaded snare and a modified Over-the-scope clip. After the procedure half of the animals were survived for 7 days, and the other half for 28 days. Complete resection (all markings included in the specimen), technical success, complication rates, wound healing on follow-up autopsy were assessed.

Results: EFTR of healthy colonic tissue was possible in all cases; two additional clips had to be placed for complete closure in one case. In one animal the preloaded closure failed and the animal was prematurely sacrificed. All other animals had an uneventful postoperative course. All 8 specimens were classified as being completely resected. Necropsy and histopathologic evaluation demonstrated well-healed resection sites with no evidence of intraabdominal infection or inadvertent organ inclusion.

Conclusion: This novel device allows for reliable full-thickness resection and closure of 2cm specimens of colonic wall in one step as well as reliable wound healing of EFTR defects.