261

NEW GENERATION ENDOSCOPIC CLIPS FOR FULL-THICKNESS DEFECT CLOSURES: A COMPARATIVE EX-VIVO, PORCINE STUDY

Date
May 18, 2024

Background
Endoscopic closure techniques have a rapidly emerging role in the management of transmural gastrointestinal defects and have been shown to be effective and safe. Through-the-scope clips (TTSC), over-the-scope clips (OTSC) and a novel endoscopic helix tacking and suture device are currently available for endoscopic full-thickness closure. However, there is a paucity of data regarding the comparative effectiveness of these tools. In this study, we aimed to evaluate the closure strength of these devices in an ex-vivo porcine stomach model.

Methods
We tested the closure strength of four endoscopic closure devices: a novel TTS clip with anochor prongs (Mantis*), an endoscopic helix tacking and suture system (X-Tack*), a conventional rotatable TTS clip (Resolution 360*), (*Boston Scientific, Marlborough, MA), and
an over-the-scope clip (OTSC, Ovesco Endoscopy USA, Cary, NC). A standardized, 1.5cm full-thickness, linear incision was made in the greater curvature of the gastric body and then subsequently closed by each device under optimal conditions. Leak pressure testing was performed by modifying a sphygmomanometer to a non-collapsable catheter placed in an inflated pig stomach. All luminal openings were closed using surgical clamps to create a sealed pressure chamber. After closure, each specimen was submerged in water, and the pressure required to achieve air leakage was recorded. This was repeated 3 times for each closure device.

Results
A total of 12 gastric closures were conducted (3 per device). The average leak pressure of the conventional rotatable TTSCs, novel TTSC with anochor prongs, OTSCs and helix tacking and suture system were 67.0 ± 8.5mmHg, 89.7 ± 5.4mmHg, 96.0 ± 7.2mmHg, and 55.7 ± 8.3 mmHg respectively (Figure 1). Pairwise comparisons using the Holm’s correction revealed that the novel TTSC with anochor prongs and OTSC both had significantly higher leak pressures than the conventional rotatable TTSCs (P = 0.016, P = 0.005) and the helix tacking and suture system (P = 0.002, P < 0.001). The leak pressure for the novel TTSC with anochor prongs and OTSCs were not significantly different.

Conclusion
Our results show the novel TTSC with anochor prongs and OTSCs achieved comparable gastric perforation closure in this ex-vivo porcine model, and both performed better than other commonly used endoscopic closure devices. This is the first study to compare these devices and may aid endoscopists in selecting the optimal tool when faced with a perforation. Further study is required to determine how factors including defect size, anatomic location, and the viability of the surrounding tissue affect performance.
Figure 1. Closure strength for full-thickness closure devices

Figure 1. Closure strength for full-thickness closure devices

Figure 2. A) Defect closed with Resolution 360 TTSC, B) Defect closed with Mantis TTSC, C) Defect closed with Ovesco OTSC, D) Defect closed with X-Tack

Figure 2. A) Defect closed with Resolution 360 TTSC, B) Defect closed with Mantis TTSC, C) Defect closed with Ovesco OTSC, D) Defect closed with X-Tack

Speakers


Tracks

Related Products

Thumbnail for NORMAL RANGE OF ENDOSCOPIC MUCOSAL OXYGEN SATURATION MEASUREMENTS IN POST-BARIATRIC SURGERY PATIENTS
NORMAL RANGE OF ENDOSCOPIC MUCOSAL OXYGEN SATURATION MEASUREMENTS IN POST-BARIATRIC SURGERY PATIENTS
Laparoscopic fundoplication in patients with a history of lung transplant has an average length of stay (LOS) of 3 days with a 30-day readmission rate of 25%, which is significantly worse compared to the non-lung transplant population…
Thumbnail for ENDOSCOPIC ULTRASOUND LIVER PALPATION AS A SCREENING TOOL FOR ADVANCED FIBROSIS AND CIRRHOSIS
ENDOSCOPIC ULTRASOUND LIVER PALPATION AS A SCREENING TOOL FOR ADVANCED FIBROSIS AND CIRRHOSIS
BACKGROUND: Hepatic encephalopathy (HE) is associated with increased mortality, falls, and frequent hospitalizations. Patient reported outcomes (PROs) are useful tools to assess health-related quality of life (HRQOL) measures such as impairment of sleep, cognition, or activity…
Thumbnail for MUCOSAL OXYGENATION SATURATION LEVELS FOLLOWING ENDOSCOPIC SLEEVE GASTROPLASTY
MUCOSAL OXYGENATION SATURATION LEVELS FOLLOWING ENDOSCOPIC SLEEVE GASTROPLASTY
Endoscopic ultrasound-guided gastroejejunostomy (EUS-GJ) has gained popularity in treating malignant gastric outlet obstruction (GOO). EUS-GJ has also been used to manage benign GOO with promising technical and clinical success…
Thumbnail for ROBOT-ASSISTED VERSUS CONVENTIONAL ENDOSCOPIC SUBMUCOSAL DISSECTION FOR COLONIC LESIONS: A RANDOMIZED, CONTROLLED, BOVINE COLON STUDY
ROBOT-ASSISTED VERSUS CONVENTIONAL ENDOSCOPIC SUBMUCOSAL DISSECTION FOR COLONIC LESIONS: A RANDOMIZED, CONTROLLED, BOVINE COLON STUDY
Endoscopic submucosal dissection (ESD) is becoming the preferred method for the management of early gastrointestinal (GI) malignancies…