Colonoscopic Full-Thickness Resection of Colon in a Porcine Model As a Prelude to Endoscopic Surgery of Difficult Colon Polyps - A Novel Technique

Abstract

Background: Colonoscopic full-thickness resection (CFTR) of colon followed by suture closure may serve as a prelude to endoluminal surgical management of difficult polyps. It will be advantageous if CFTR followed by suture closure can be performed anywhere in the colon. AIMS: To evaluate the performance, safety, & effectiveness of CFTR followed by suture closure in a porcine model using novel through the scope (TTS) cutting & suturing devices. Methods: A 2-T endoscope was used for the study (n = 10). TTS-CFTR involves 2 steps.a) Resection: A 2 cm circular area was marked with needle knife cautery at 20 cm from the anus. An IT-knife was used to cut the colon from 1'O clock to 5'O clock in the anti-clock direction along the markings. A grasping forceps & a snare inserted through the left & right channels of the endoscope were used to lift & cut the remaining half segment of the colon between 5'O clock & 1'O clock, thus completing the CFTR. The specimen was retrieved with the grasping forceps for measurements. b) Closure: The tissue approximation device (Ethicon Endosurgical Inc) was used to close the hole by full-thickness suture approximation of the edges transversely.Measurements: Resection and closure times & resection specimen sizes were expressed as median (range). Follow-up: After 2 wks of survival, the animals were euthanized & examined for peritonitis, adhesions, wound healing by leak test, & T-tag injury to the adjacent viscera. Results: a) Resection: An IT-knife semicircular incision followed by snare resection of the remaining half was successful in all 10 attempts. There was no injury to the adjacent viscera. The resection time was 13.5 min (6 - 40 min) & the resected specimen was 1.6 cm (1-2 cm). b) Closure: Suture closure was successful in 9 of 10 attempts; in 1 animal with a 3-4 cm gap, snapping of the sutures resulted in failure to close the defect. The number of sutures required for closure was 3 (range: 3-4). The suture closure time was 57 min (range: 36-125 min). c) Follow-up: Of the 9 animals with successful closure, 8 survived without clinical signs of distress; necropsy at 2 wks revealed absence of peritonitis & distant adhesions. There was excellent healing of the wound & no dye leakage. One animal failed to thrive & necropsy revealed peritonitis, multiple small abscesses, distant adhesions, & dye leak from a 2 mm defect. Of the 60 T-tags, 2 tags were noted in the serosa of the bladder & colon respectively, but without any complications. Conclusions: Colonoscopic full-thickness resection of the colon followed by suture closure can be accomplished successfully using through the scope devices.