Percutaneous Access to Colon under a Double-balloon Endolumenal Platform for Tumor Excision: Ex-vivo Trials and Clinical Experience Young Award

Introduction: Endolumenal therapies can be complex. There are reports on successful percutaneous access (PA) for upper GI lesions. Therefore, we evaluated the feasibility and potential for clinical use of PA to the colon.Methods: Using a 3D model with a porcine colorectum and abdominal wall, we secured the Cecum to the abdominal wall with T-fasteners (HALYARD) and inserted 8Fr and 10Fr vascular sheaths under an endoscopic view (OLYMPUS) with a double-balloon endolumenal platform (DEIP, Lumendi, LLC). 3cm lesions at the posterior wall of the Cecum were removed in two ways; (1) standard technique with ESD knife (OLYMPUS): STD, (2) PA with grasper and electrosurgery (Gimmi) through sheaths: PA. Next, we closed puncture sites with clips (OLYMPUS) and measured leak pressures. We also used this technique in a clinical case.Results: Setup time for PA was 4.4 min. A total of 24 lesions were removed without perforation. PA group had a significantly shorter total procedure time (STD vs. PA=43.8 vs. 11.5 min) and fewer muscular injuries (3 vs. 0) than the STD group. Closure time was 3.2 min, and no leakage was noted up to 60 mmHg. In a clinical case, 6x4cm sessile polyp at the posterior wall of the Cecum was removed in the same manner, illustrated with a short video. She was discharged on POD 1 without complications. Pathology was tubular adenoma.Conclusion: In preclinical trials, PA for tumor excision appears to be feasible and effective. Although results are preliminary, PA has the potential for clinical applications.