Vacuum inversion and securing of distal colonic pseudodiverticula with novel spiked O-rings
| Autor: | Wayne A. Noda, Erna Granic, Giovanni Cassata, Christoph Gasche, Giorgio Romano, Giuseppe Amato, Gerd R. Silberhumer, Tudor Birsan, Susanna Lang, Antonino Agrusa, Roberto Puleio |
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| Přispěvatelé: | Amato, G, Birsan, T, Granic, E, Silberhumer, G, Cassata, G, Agrusa, A, Puleio, R, Romano, G, Lang, S, Noda, W, Gasche C |
| Rok vydání: | 2015 |
| Předmět: |
medicine.medical_specialty
Vacuum Swine Forceps Connective tissue gastrointestinal endoscopy Diverticulum Colon Animal model medicine Animals Humans Radiology Nuclear Medicine and imaging Prospective Studies Laparoscopy medicine.diagnostic_test business.industry Gastroenterology digestive system diseases Surgery Settore MED/18 - Chirurgia Generale medicine.anatomical_structure diverlite Diverticular disease Tissue necrosis Female Cadaveric spasm business Ligation |
| Zdroj: | Gastrointestinal Endoscopy. 81:749-755 |
| ISSN: | 0016-5107 |
| DOI: | 10.1016/j.gie.2014.09.051 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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