Endoscopic full-thickness resection and defect closure in the colon

Renteln, Daniel von; Schmidt, Arthur; Vassiliou, Melina C.; Rudolph, H.-U.; Caca, Karel

doi:10.1016/j.gie.2009.12.056

Cited by 85 publications

(57 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Lesion size could be of concern, although in our series all lesions up to 30 mm were closed by applying just one clip. There are data about the limitations of OTSC for perforations within the colon larger than 27 mm in an animal non survival study of 14 pigs [18]. We postulate that the critical size of defects could be extended by a few millimeters when the tissue is pulled into the OTSC cap without any difficulty.…”

Section: Discussionmentioning

confidence: 96%

Endoscopic Closure of Iatrogenic Gastrointestinal Tract Perforations with the Over-the-Scope Clip

Gubler

Bauerfeind²

2012

Digestion

View full text Add to dashboard Cite

Background: Newer techniques such as mucosal resection, submucosal dissection and risky polypectomy will probably lead to increasing numbers of iatrogenic perforations. Reliable immediate closure of these lesions would increase safety and acceptance of the interventions. Methods: All acute directly observed perforations during diagnostic or therapeutic endoscopy were treated by the application of an over-the-scope clip. All consecutive patients from 2009 to August 2011 were followed in our tertiary referral center. The main outcome was technically successful closure of the perforation during endoscopy with a subsequent clinical observation for 24 h. Results: During the observation period, acute perforation occurred in 14 patients. All but 1 patient had technically successful treatment. Due to persistent abdominal pain, 3 patients had to be sent to the theater for laparoscopic evaluation after colon perforation. These 3 lesions were proven to be sealed and no resection of the colon was indicated. One patient with gastric adenocarcinoma had to be resected subtotally following endoscopic mucosal resection. Hospital stay ranged from 2 to 21 days. Conclusion: Directly observed perforations up to 30 mm diameter during endoscopy should be treated by deploying an over-the-scope clip. Endoscopists should be encouraged to be trained and to use over-the-scope clips in the stomach, duodenum and colon.

show abstract

Section: Discussionmentioning

confidence: 96%

Endoscopic Closure of Iatrogenic Gastrointestinal Tract Perforations with the Over-the-Scope Clip

Gubler

Bauerfeind²

2012

Digestion

View full text Add to dashboard Cite

show abstract

“…Therefore, re-engineering of the cap design is necessary. In three cases, the first OTSC did not deploy due to friction and entangling of the anchoring device with the OTSC release wire in the 2.8-mm working channel; we did not encounter such problems in previous OTSC studies [19][20][21][22], in which a 3.2-mm working channel or a double-channel endoscope were used. Use of a larger working channel can minimize such problems.…”

Section: Discussionmentioning

confidence: 90%

“…The median procedure time was 15 min (IQR [11][12][13][14][15][16][17][18][19][20][21][22]. Full-thickness resections produced complete gastric wall defects in 3/6 (50%) cases.…”

Section: Resultsmentioning

confidence: 99%

“…If pure endoscopic resection is to play a role in this setting, endoscopic full-thickness resection (EFTR) with reliable defect closure is the aim which should be strived for. Based on the results of our previous EFTR study [19], a novel prototype EFTR device has been developed. The aim of this study was to evaluate a novel EFTR prototype device for the resection of artificial gastric SMTs in the animal model.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Endoscopic Full-Thickness Resection of Submucosal Gastric Tumors

et al. 2012

Self Cite

View full text Add to dashboard Cite

show abstract

“…There have been some previous studies of EFTR without transmural communication [14][15][16]. In these techniques, a pseudopolyp is first created by using a grasping or lifting device, and fixed with or without an endoloop, and finally resected with an electrocautery snare or specialized equipment such as a flexible stapling device.…”

Section: Discussionmentioning

confidence: 99%

New method of endoscopic full-thickness resection: a pilot study of non-exposed endoscopic wall-inversion surgery in an ex vivo porcine model

et al. 2011

View full text Add to dashboard Cite

The indications for endoscopic full-thickness resection (EFTR) are limited because transmural communication during the entire procedure, causing tumor dissemination into the abdominal space, is inevitable. We invented a new method of EFTR without transmural communication, and explored its feasibility in an ex vivo porcine model. Three explanted porcine stomachs were used. First, markings around a model lesion were made with a flexible endoscope, and 0.9% normal saline with indigocarmine was injected into the submucosa around the markings. Second, a circumferential sero-muscular incision was made from the outside with an electrocautery knife, guided by the color of the submucosal injection and intragastric navigation with the endoscope. Third, the muscle layer was linearly sutured with the lesion inverted into the inside. Finally, a circumferential muco-submucosal incision was made with an electrocautery knife employed with the endoscope. The method was performed for 3 lesions (1 anterior wall, 1 lesser curve, and 1 posterior wall of the gastric body), and all lesions were successfully resected in en-bloc fashion. The mean size of the resected specimen was 4.5 cm in diameter. Neither perforation nor apparent air leakage was seen during or after the resection. Non-exposed endoscopic wall-inversion surgery (NEWS) is thought to be effective as a minimally invasive, and minimal-size endoluminal surgery for gastric submucosal tumors with or without ulceration, or even node-negative early gastric cancer that is difficult to resect by endoscopic submucosal dissection.

show abstract

Endoscopic full-thickness resection and defect closure in the colon

Cited by 85 publications

References 30 publications

Endoscopic Closure of Iatrogenic Gastrointestinal Tract Perforations with the Over-the-Scope Clip

Endoscopic Closure of Iatrogenic Gastrointestinal Tract Perforations with the Over-the-Scope Clip

Endoscopic Full-Thickness Resection of Submucosal Gastric Tumors

New method of endoscopic full-thickness resection: a pilot study of non-exposed endoscopic wall-inversion surgery in an ex vivo porcine model

Contact Info

Product

Resources

About