Doctors in Southampton are the first in the UK to use a pioneering “bear claw” device that removes the need for invasive surgery in patients with precancerous bowel tumours.
The procedure, performed by Dr Philip Boger, a consultant in gastroenterology and advanced endoscopy at Southampton General Hospital, involves placing a cap over flexible thin tube – colonoscope – and attaching a novel clip to the tip.
It is then passed into the bowel to the site of the growth where it is slowly pulled into the cap before the clip is released to seal the surrounding area. The diseased tissue is then promptly removed using a wire lasso.
Although similar procedures exist, currently available options can only remove a thin layer of tissue due to the risk of causing a life-threatening perforation, leading to recurrence in around a quarter of cases and resulting in the need for surgical intervention.
The new technique, which uses equipment known as a full-thickness resection device (FTRD), allows doctors to remove deeper layers of tissue non-surgically for the first time as the “claw” prevents damage to the lining of the bowel.
Dr Boger, who has performed the procedure on three patients so far, said it marked a “milestone” as many patients would no longer be faced with major abdominal surgery and the risk of requiring a colostomy bag to be fitted to the stomach.
“Until now, we have been limited non-surgically to dealing with surface layer tumours due to the risk of perforation and bleeding and inadequate depth of excision allowed,” he said.
“But this device enables us to secure the surrounding area with a bear-like “claw” clip before removing the diseased tissue, which means we can protect the bowel and remove that risk.”
The first patient to undergo the procedure was suffering from a neuroendocrine tumour, a tumour which develops in the cells of the hormonal and nervous systems and can affect a number of areas of the body, and would previously have required surgery to remove it.
Dr Boger explained: “Our first patient had undergone a previous procedure but the tumour had not been excised completely due to the risk of perforation and scans suggested she had a deeper component under the surface of the lining of the bowel.
“If left, there was a risk it would become cancerous and spread to the lymph nodes in future and, before this device, the only alternative intervention would have been major abdominal surgery with high risk of the patient requiring a stoma bag.
“However, we were able to completely remove the mass using the FTRD quickly with minimal discomfort for the patient, minimal risk and very little recovery time.”
Full-thickness resection, which is performed by a team of doctors and nurses who specialise in endoscopic procedures, takes around 35 to 50 minutes to complete and patients return home the same day.
Dr Boger added: “This does mark a major milestone as we now envisage being able to remove the full thickness of the bowel this way in many more cases, preventing the need for those patients to undergo surgical intervention with its associated risks and recovery time.”
He and his team were assisted during the first three cases at Southampton General Hospital by Professor Thomas Gottwald, who pioneered the procedure with colleagues at the University of Tuebingen in Germany.
Posted on Monday 18 May 2015