Researchers present a video demonstrating how a full-thickness resection device allows for safe, single-step endoscopic removal and closure of a diverticular adenoma, without leakage of bowel content into the peritoneal cavity. This system, described in the November issue of Gastroenterology, allows for secure resection of high-risk lesions and might even be performed in an outpatient setting.
Neoplastic lesions arising from a diverticulum are at risk for perforation during endoscopic resection. Piero V. Valli et al demonstrate how an over-the-scope clip and full-thickness resection device can be used in en bloc resection and closure of a 10-mm polyp detected within a diverticulum in the ascending colon:
The lesion was marked with India ink and a hemoclip, the standard colonoscope was withdrawn, and a therapeutic colonoscope was fitted with the full-thickness resection device, comprising a transparent cap (containing a hyperthermic snare) and an over the scope clip. The colonoscope was mounted with the full-thickness resection device and then advanced to the marked adenoma within the diverticulum.
The adenoma was drawn into the plastic cap either with grasping forceps or by suction. Thereafter, the over-the-scope clip was deployed, the snare was closed, and full-thickness colon resection was performed using standard polypectomy. The full-wall resection specimen remained in the plastic cap and was retrieved.
Inspection of the colon after the procedure confirmed that a full-thickness sample was removed, based on the presence of peritoneal fatty tissue and colonic wall within the resection site.