Colonoscopic full-thickness resection of the colon in a porcine model as a prelude to endoscopic surgery of difficult colon polyps: a novel technique (with videos)

Background: Colonoscopic full-thickness resection (CFTR) of the colon may obviate the need for surgical resection of benign lesions. Objective: To develop an animal model for CFTR of the colon followed by endoscopic suture closure with through-the-endoscope devices. Design: Pilot study. Setting: University medical center. Animals: Twenty pigs. Interventions: A 2-cm circular area was resected on the antimesenteric side of the colon (phase 1, n = 10) and on the mesenteric side (phase 2, n = 10) by using an insulated tip knife cut followed by the use of a grasping forceps and a snare to resect and retrieve the specimen. The tissue apposition system was used to close the defect. Main Outcome Measurements: Resection and closure times were recorded. The animals were euthanized at 2 weeks and examined for peritonitis, adhesions, wound healing, and T-tag injury to adjacent viscera. Results: The CFTR was successful in all 20 attempts. The median resection time was 6 minutes (range 2.5-35 minutes). Suture closure was successful in 19 animals. It took a median time of 41 minutes (range 21-125 minutes) and 4 sutures to close the defect. Eighteen animals survived without clinical signs of distress; there was a well-healed scar without peritonitis or distant adhesions on necropsy at 2 weeks. One animal failed to thrive, and necropsy revealed mild peritonitis, small abscesses, distant adhesions, and a 2-mm hole at the suture site. Two of the 132 T-tags were inserted in the adjacent viscera. Limitations: Colon resection in the proximal colon was not studied. Conclusions: In this animal model, CFTR of the colon followed by suture closure can be accomplished successfully by using through-the-endoscope devices.