New methodsExperimental endoscopyVacuum inversion and securing of distal colonic pseudodiverticula with novel spiked O-rings

BackgroundDiverticular disease is increasingly prevalent in Western societies and is associated with significant morbidity.ObjectiveTwo-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.DesignProspective, observational study of human cadavers and prospective, interventional study of a porcine model.SettingUniversity hospital pathology laboratory and animal facility.InterventionFull-thickness inversion of the colonic wall with a pipelike delivery instrument to produce an inverted pseudodiverticulum that was secured with a spiked O-ring.Main Outcome MeasurementsThe forces required for diverticular inversion, the secured closure of inverted pseudodiverticula, and the time until necrotic tissue falls off.ResultsA 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.LimitationsAnimal model, stiff pipelike delivery instrument, variations in diverticular location, diameter, and size.ConclusionsEndoluminal inversion and securing of colonic diverticula induces tissue necrosis, diverticular sloughing, and full-thickness scarring.