Endoscopic colotomy closure after full thickness excision: comparison of T fastener with multiclip applier

Background and study aims: Safe, reliable, and efficient endoscopic closure of a colotomy is paramount for endoscopic full thickness excision of the colon. Two newly developed devices, the Tissue Apposition System (TAS) and the InScope Multi-Clip Applier (IMCA), may help to achieve this. The aim of this study was to determine the feasibility of using each device to close colotomies after full thickness wall excisions. Material and methods: 12 pigs were used in the study. After laparoscopic full thickness excision of the colonic wall, the defect was closed using either the TAS or the IMCA. Closure was performed under laparoscopic vision. Success of colotomy closure, time taken for colotomy closure, postoperative infections, and complication rates were recorded. Results: Complete closure was achieved in 6/6 pigs in the TAS group. In 5/6 pigs in the IMCA group closure was successful; in one pig laparoscopic assistance was used. Median closure time (range) was significantly lower in the TAS group at 48 minutes (15-51) vs. 76 minutes (43-145) in the IMCA group. There were no postoperative infections or complications. Conclusions: Endoscopic closure after full thickness colonic wall excision is feasible with both the TAS and the IMCA. Closure times are significantly shorter and handling is easier with the TAS. Combined use of both systems might be beneficial.