Endoscopy 2017; 49(11): 1092-1097
DOI: 10.1055/s-0043-114730
Innovations and brief communications
© Georg Thieme Verlag KG Stuttgart · New York

Colorectal endoscopic full-thickness resection using a novel, flat-base over-the-scope clip: a prospective study

Yara Backes
1   Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
,
Wouter F. W. Kappelle
1   Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
,
Luuk Berk
2   Department of Gastroenterology and Hepatology, Sint Fransciscus Hospital, Rotterdam, The Netherlands
,
Arjun D. Koch
3   Department of Gastroenterology and Hepatology, Erasmus MC – University Medical Center, Rotterdam, The Netherlands
,
John N. Groen
4   Department of Gastroenterology and Hepatology, St. Jansdal, Harderwijk, The Netherlands
,
Wouter H. de Vos tot Nederveen Cappel
5   Department of Gastroenterology and Hepatology, Isala, Zwolle, The Netherlands
,
Matthijs P. Schwartz
6   Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort, The Netherlands
,
Marjon Kerkhof
7   Department of Gastroenterology and Hepatology, Groene Hart Hospital, Gouda, The Netherlands
,
Peter D. Siersema
1   Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
,
Roland Schröder
8   Department of Gastroenterology and Hepatology, Gelre Hospital, Apeldoorn, The Netherlands
,
T. G. Tan
9   Department of Gastroenterology and Hepatology, Medical Center de Veluwe, Apeldoorn, The Netherlands
,
Miangela M. Lacle
10   Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
,
Frank P. Vleggaar
1   Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
,
Leon M. G. Moons
1   Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
,
on behalf of the T1 CRC Working Group › Institutsangaben
Weitere Informationen

Publikationsverlauf

submitted 07. Februar 2017

accepted after revision 26. Mai 2017

Publikationsdatum:
28. Juli 2017 (online)

Abstract

Background and study aims We aimed to evaluate the feasibility and safety of a new, flat-based over-the-scope clip (Padlock Clip) for colorectal endoscopic full-thickness resection (eFTR).

Patients and methods We prospectively included 26 patients with lesions < 20 mm. Indications for eFTR were re-resection of the scar of a low risk malignant polyp (n = 11), recurrent adenoma in a non-lifting scar (n = 10), non-lifting polyp (n = 4), and an adenoma located in a diverticulum (n = 1).

Results Technical success rate and full-thickness resection rate were 100 % (26/26) and 92 % (24/26), respectively. Median procedure time was 43 minutes (IQR 27 – 56). No complications occurred during the procedure; 3 complications (12 %) occurred within 48 hours, of which one was a perforation requiring laparoscopic suturing. Specimen volumes from eFTR of scar tissue where the original polyp had been ≥ 20 mm (n = 13) were smaller compared with those from non-scar resections or scars where the original polyps had been < 20 mm (n = 13) (median 0.8 vs. 1.5 cm3, P = 0.03).

Conclusions In this first series of colorectal eFTR using the Padlock Clip, feasibility was demonstrated. It was relatively safe in view of surgery as the alternative treatment, but could still benefit from technical refinement. Future studies should explore for which indication this technique is most suitable.

Trial registration: NTR5562 (Dutch Trial Register).

 
  • References

  • 1 Verweij NM, Schiphorst AH, Maas HA. et al. Colore2011 and 2012 in The Netherlands. Ann Surg Oncol 2016; 23: 1875-1882
  • 2 Schmidt A, Bauerfeind P, Gubler C. et al. Endoscopic full-thickness resection in the colorectum with a novel over-the-scope device: first experience. Endoscopy 2015; 47: 719-725
  • 3 Fahndrich M, Sandmann M. Endoscopic full-thickness resection for gastrointestinal lesions using the over-the-scope clip system: a case series. Endoscopy 2015; 47: 76-79
  • 4 Sarker S, Gutierrez JP, Council L. et al. Over-the-scope clip-assisted method for resection of full-thickness submucosal lesions of the gastrointestinal tract. Endoscopy 2014; 46: 758-761
  • 5 Schmidt A, Damm M, Caca K. Endoscopic full-thickness resection using a novel over-the-scope device. Gastroenterology 2014; 147: 740-742 e742
  • 6 Valli PV, Kaufmann M, Vrugt B. et al. Endoscopic resection of a diverticulum-arisen colonic adenoma using a full-thickness resection device. Gastroenterology 2014; 147: 969-971
  • 7 Guarner-Argente C, Cordova H, Martinez-Palli G. et al. Yes, we can: reliable colonic closure with the Padlock-G clip in a survival porcine study (with video). Gastrointest Endosc 2010; 72: 841-844
  • 8 Backes Y, Moons LM, van Bergeijk JD. et al. Endoscopic mucosal resection (EMR) versus endoscopic submucosal dissection (ESD) for resection of large distal non-pedunculated colorectal adenomas (MATILDA-trial): rationale and design of a multicenter randomized clinical trial. BMC Gastroenterol 2016; 16: 56
  • 9 Reumkens A, Rondagh EJ, Bakker CM. et al. Post-colonoscopy complications: a systematic review, time trends, and meta-analysis of population-based studies. Am J Gastroenterol 2016; 111: 1092-1101
  • 10 Paice JA, Cohen FL. Validity of a verbally administered numeric rating scale to measure cancer pain intensity. Cancer Nurs 1997; 20: 88-93
  • 11 Schlemper RJ, Riddell RH, Kato Y. et al. The Vienna classification of gastrointestinal epithelial neoplasia. Gut 2000; 47: 251-255
  • 12 Armellini E, Crino SF, Orsello M. et al. Novel endoscopic over-the-scope clip system. World J Gastroenterol 2015; 21: 13587-13592
  • 13 Brindley JH, Yip B, Vlachou E. et al. Successful endoscopic closure of a gastrocutaneous fistula using a “Padlock Clip”. Endoscopy 2016; 48 (Suppl. 01) E115-116
  • 14 Abraham A, Vasant DH, McLaughlin J. et al. Endoscopic closure of a refractory gastrocutaneous fistula using a novel over-the-scope Padlock clip following de-epithelialisation of the fistula tract. BMJ Case Rep 2015; 2015
  • 15 Diana M, Swanstrom LL, Halvax P. et al. Esophageal covered stent fixation using an endoscopic over-the-scope clip. Mechanical proof of the concept and first clinical experience. Surg Endosc 2015; 29: 3367-3372