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- Title
A comparison of two endoscopic closures: over-the-scope clip (OTSC) versus KING closure (endoloop + clips) in a randomized long-term experimental study.
- Authors
Dolezel, R.; Ryska, O.; Kollar, M.; Juhasova, J.; Kalvach, J.; Ryska, M.; Martinek, J.
- Abstract
<bold>Background: </bold>Both over-the-scope clip (OTSC) and KING (endoloop + clips) closures provide reliable and safe full-thickness endoscopic closure. Nevertheless, OTSC clip demonstrated significantly inferior histological healing in the short-term follow-up.<bold>Aim: </bold>To compare OTSC versus KING closure of a perforation with regard to long-term effectiveness and macroscopic and histological quality of healing.<bold>Methods: </bold>We performed a randomized experimental study with 16 mini-pigs (mean weight 43.2 ± 11.2 kg). A standardized perforation was performed on the anterior sigmoid wall. KING closure (n = 8) was attained by approximation of an endoloop fixed to the margins of a perforation with endoclips. OTSC closure (n = 8) was performed by deploying OTSC (OVESCO) over the defect. Pigs underwent a control sigmoidoscopy 8 months after the closure to assess the macroscopic quality of healing. Then, autopsy was performed and the rectosigmoid was sent for histopathological assessment.<bold>Results: </bold>All closures were completed successfully without air leaks. The duration of closure was similar in both techniques (OTSC 17.8 ± 7.6 min vs. KING 19.6 ± 8.8 min). At autopsy, all KING closures (100 %) were healed with a flat scar without signs of leakage. Microscopically, no inflammatory changes were observed after KING closure. In the OTSC group, microscopic ulcers were present in two pigs (25 %), cryptal abscesses in three pigs (38 %) and significant neutrophil accumulation in all eight pigs (P < 0.01). Giant cell granulomas, dysplasia or abundant scarification was not observed in either group.<bold>Conclusions: </bold>Both OTSC and KING closures offer a long-term reliable seal of a gastrointestinal perforation without stenosis or fistulas. KING closure provides long-term histologically superior healing.
- Subjects
ENDOSCOPIC surgery; SIGMOIDOSCOPY; AUTOPSY; STENOSIS; FOLLOW-up studies (Medicine); COLON surgery; ANIMAL experimentation; COLON (Anatomy); COMPARATIVE studies; ENDOSCOPY; LONGITUDINAL method; RESEARCH methodology; MEDICAL cooperation; RESEARCH; STATISTICAL sampling; SURGICAL instruments; SUTURING; SWINE; WOUND healing; EVALUATION research
- Publication
Surgical Endoscopy & Other Interventional Techniques, 2016, Vol 30, Issue 11, p4910
- ISSN
1866-6817
- Publication type
journal article
- DOI
10.1007/s00464-016-4831-z