Endoluminal full-thickness resection of GI lesions: a new device and technique.

Full-thickness resection techniques are of growing interest in the field of endoscopic removal of tumors or their precursors in the digestive tract. A new dedicated full-thickness resection device has been developed based on the combination of the OTSC clip, an enlarged resection cap and an integrated snare. The device prototype allows combined resection of all gastrointestinal organ wall layers in one maneuver, up to a size of 3 x 3 cm. The device has been pre-clinically tested to demonstrate feasibility of full-thickness resection in the colon. Two clinical cases have been performed successfully to date.

The OTSC clip for endoscopic organ closure in NOTES: device and technique.

The closure of the gastrotomy in Natural Orifice Transluminal Endoscopic Surgery (NOTES) is a prerequisite for transgastric endoscopic procedures in the abdominal cavity. Different techniques have been proposed and are under experimental or early clinical investigation. We describe the technique of using an over-the-scope-clip system (OTSC), made of super-elastic Nitinol and a specially designed tissue-approximating double jaw endoscopic grasper for gastric closure. The OTSC is a clipping system mounted at the tip of the endoscope and is used for the treatment of gastrointestinal bleeding or gastrointestinal organ perforations. An enlarged version of the OTSC is now under investigation for NOTES. The closure procedure consists of two steps. First the margins of the perforation are approximated by means of an endoscopic grasper that has two mobile and one fixed jaw, thus providing two independent tissue grasping areas. Each half of this twin grasper is used to grasp one side of the perforation wound margins. Then the margins are approximated and pulled towards the OTSC cap at the tip of the scope. Then the clip is released and the access hole is closed by compression. The OTSC clip can be applied for organ closure in NOTES in experimental studies. The technique allows closing the access site from inside the gastric cavity without leaving material on the peritoneal surface of the organ.