Vacuum inversion and securing of distal colonic pseudodiverticula with novel spiked O-rings.
Gastrointest Endosc
; 81(3): 749-55, 2015 Mar.
Article
em En
| MEDLINE
| ID: mdl-25484325
ABSTRACT
BACKGROUND:
Diverticular disease is increasingly prevalent in Western societies and is associated with significant morbidity.OBJECTIVE:
Two-stage endoscopic device development for inversion and secured ligation of colonic diverticula; first, human cadaver studies were performed to measure forces required for diverticular inversion; second, a novel set of devices (elastic spiked O-ring with delivery system) was tested in animals.DESIGN:
Prospective, observational study of human cadavers and prospective, interventional study of a porcine model.SETTING:
University hospital pathology laboratory and animal facility. INTERVENTION Full-thickness inversion of the colonic wall with a pipelike delivery instrument to produce an inverted pseudodiverticulum that was secured with a spiked O-ring. MAIN OUTCOME MEASUREMENTS The forces required for diverticular inversion, the secured closure of inverted pseudodiverticula, and the time until necrotic tissue falls off.RESULTS:
A total of 248 of 248 of cadaveric sigmoid diverticula could be inverted by means of vacuum or forceps. The forces required for inversion ranged from 0.28 to 0.47 N (median, 0.37 N). Twenty-four spiked O-rings were delivered in 6 living pigs to produce 24 inverted pseudodiverticula. One animal died the day after the procedure of a pulmonary thromboembolism. In the remaining 5 pigs, all delivered spiked O-rings remained in place for 7 to 22 days. At necropsy, none of the inverted sites showed signs of perforation but rather full-thickness reparative scarring with ingrowth of connective tissue.LIMITATIONS:
Animal model, stiff pipelike delivery instrument, variations in diverticular location, diameter, and size.CONCLUSIONS:
Endoluminal inversion and securing of colonic diverticula induces tissue necrosis, diverticular sloughing, and full-thickness scarring.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Laparoscopia
/
Divertículo do Colo
Tipo de estudo:
Observational_studies
/
Risk_factors_studies
Limite:
Animals
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Female
/
Humans
Idioma:
En
Ano de publicação:
2015
Tipo de documento:
Article