A New Endoluminal Platform For Endoscopic Removal of Difficult Colonic Lesions: Initial Clinical Experience.

Sergey V Kantsevoy, MD, PhD, Marianne Bitner, CRNA, B R Liu, MD, PhD, Gregory Piskun, MD. University of Maryland School of Medicine, Mercy Medical Center, Baltimore, Maryland, USA.

OBJECTIVE: To develop a new platform facilitating endoscopic removal of large and flat colonic lesions.

DESCRIPTION OF THE TECHNOLOGY: LumenR retractor system consists of an expandable and dynamically-controlled intra-luminal chamber, mounted on a flexible overtube, and two associated articulating instrument guides. The system is front-loaded over the colonoscope and introduced into the colon. When the target area is reached, the retractor system is deployed creating an expanded, optimally reconfigured and stable operating field around the target lesion. Then endoscopic removal of the lesion is performed using commercially available endoscopic instruments (forceps, injection needles, snares, clips, etc) through the biopsy channel of the colonoscope with assistance of two articulating instrument guides of the LumenR retractor system, operating independently of the colonoscope and each other.

PRELIMINARY RESULTS: Mercy Medical Center IRB approved our initial clinical study. We performed successful removal of large, flat colonic lesions in 4 consecutive patients. Delivery and deployment of the LumenR retractor system created a stable and optimally reconfigured operating space around the target lesion, which markedly decreased the need for intra-luminal insufflation.  This space was sufficient to accommodate the colonoscope and comfortably perform regular manipulations (advancement and turning of its tip and axial rotation of its shafts). Delivery of endoscopic accessories through the LumenR articulating instrument guides added 2 extra “arms” for various manipulations (grasping, pulling, pushing, etc), creating an effect of triangulation closely resembling laparoscopic procedures. All lesions were removed en block by endoscopic submucosal dissection without any problems or complications.

CONCLUSIONS: LumenR retractor system allows creation of a stable and optimally reconfigured operating space inside the colon with delivery of additional endoscopic instruments in triangulating fashion. This novel endoscopic platform has a potential to improve and simplify endoscopic removal of difficult (large and flat) benign and early malignant colonic lesions.