title: Vacuum inversion and securing of distal colonic pseudodiverticula with novel spiked O-rings.
abstract: BACKGROUND
  Diverticular disease is increasingly prevalent in Western societies and is associated with significant morbidity.
  
  
  OBJECTIVE
  Two-stage endoscopic device development for inversion and secured ligation of colonic diverticula; first, human cadaver studies were performed to measure forces required for diverticular inversion; second, a novel set of devices (elastic spiked O-ring with delivery system) was tested in animals.
  
  
  METHODS
  Prospective, observational study of human cadavers and prospective, interventional study of a porcine model.
  
  
  METHODS
  University hospital pathology laboratory and animal facility.
  
  
  METHODS
  Full-thickness inversion of the colonic wall with a pipelike delivery instrument to produce an inverted pseudodiverticulum that was secured with a spiked O-ring.
  
  
  METHODS
  The forces required for diverticular inversion, the secured closure of inverted pseudodiverticula, and the time until necrotic tissue falls off.
  
  
  RESULTS
  A total of 248 of 248 of cadaveric sigmoid diverticula could be inverted by means of vacuum or forceps. The forces required for inversion ranged from 0.28 to 0.47 N (median, 0.37 N). Twenty-four spiked O-rings were delivered in 6 living pigs to produce 24 inverted pseudodiverticula. One animal died the day after the procedure of a pulmonary thromboembolism. In the remaining 5 pigs, all delivered spiked O-rings remained in place for 7 to 22 days. At necropsy, none of the inverted sites showed signs of perforation but rather full-thickness reparative scarring with ingrowth of connective tissue.
  
  
  CONCLUSIONS
  Animal model, stiff pipelike delivery instrument, variations in diverticular location, diameter, and size.
  
  
  CONCLUSIONS
  Endoluminal inversion and securing of colonic diverticula induces tissue necrosis, diverticular sloughing, and full-thickness scarring.
authors.affiliation: Department of General Surgery and Urgency, University of Palermo, Palermo, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Amato
authors.affiliation: Department of General Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Tudor
authors.initials: T
authors.lastname: Birsan
authors.affiliation: Department of General Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Erna
authors.initials: E
authors.lastname: Granic
authors.affiliation: Department of General Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Gerd
authors.initials: G
authors.lastname: Silberhumer
authors.affiliation: Experimental Zooprophylactic Institute A. Mirri, Palermo, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cassata
authors.affiliation: Department of General Surgery and Urgency, University of Palermo, Palermo, Italy.
authors.forename: Antonino
authors.initials: A
authors.lastname: Agrusa
authors.affiliation: Experimental Zooprophylactic Institute A. Mirri, Palermo, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Puleio
authors.affiliation: Department of General Surgery and Urgency, University of Palermo, Palermo, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Romano
authors.affiliation: Department of Pathology, Medical University of Vienna, Vienna, Austria.
authors.forename: Susanna
authors.initials: S
authors.lastname: Lang
authors.affiliation: Insightra Inc, Irvine, CA, USA.
authors.forename: Wayne
authors.initials: W
authors.lastname: Noda
authors.affiliation: Department of Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria.
authors.forename: Christoph
authors.initials: C
authors.lastname: Gasche
mesh_terms: D000818:Animals; D004241:Diverticulum, Colon / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods*; D011446:Prospective Studies; D013552:Swine; D014618:Vacuum