Comparison of clipping and endoscopic band ligation treatment for the colonic wall: an in vivo animal study

TL;DR

This study compares clipping and endoscopic band ligation for treating colonic wall issues in pigs, finding that clipping causes less tissue damage.

Contribution

The study provides new insights into the comparative pathologic effects of clipping and endoscopic band ligation on the colonic mucosa.

Findings

Clipping caused significantly less necrosis and fibrosis compared to endoscopic band ligation.

Endoscopic band ligation resulted in more extensive fibrosis extending to the serosa.

No perforation was observed in either treatment group.

Abstract

Although clipping is a simple and widely used treatment for colonic diverticular bleeding, endoscopic band ligation (EBL) has recently been reported to be more effective than clipping in preventing recurrent bleeding. However, the pathologic effects of these treatments on the colonic mucosa remain unclear. This study compares the effects of those treatments on the colonic mucosa using a pig model.

Six clipping procedures and 6 EBL procedures each were performed on the normal colon of the pig, with the clipping and EBL sites separated by approximately 1 cm. The procedure was performed by an expert endoscopist. The pig was killed 10 days after the procedures, and the specimens were compared for pathologic evaluation of necrosis, fibrosis, and disruption of the muscularis mucosae of the colonic mucosa to determine the effects on the colonic mucosa.

All bands and clips remained in the procedure site; no perforation was observed at either site. Necrosis was significantly less in the clip group (P = .002). Disruption of the muscularis mucosae was less common in the clip group, but the difference was not significant (P = .181). Fibrosis of the submucosa was less in the clip group (0 of 6) than in the EBL group (6 of 6) (P = .002). Fibrosis extending to the serosa was less in the clip group but was not statistically significant: 0 (0%) in the clip group and 4 (66.7%) in the EBL group (P = .061).

The impact on the colonic mucosa is small and localized with clipping but large and extensive with EBL.

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