Safety of the NiTi EndoCAR Following Chemoradiation in a Porcine Model

Abstract

Rectal anastomosis, after chemoradiation to the pig rectum using a ring (EndoCAR), is similar to stapled anastomosis. Further trials are needed in humans to determine any clinical advantage associated with these findings.

COMPRES: a prospective postmarketing evaluation of the compression anastomosis ring CAR 27™/ColonRing™

“…The significant difference in leak rate between a historical stapled and nitinol compression anastomosis in the present study after low anterior resection needs confirmation. If this is a true difference, it is possible that biological factors might play a role by reducing the inflammatory response during anastomotic healing or by upregulating collagenase formation reducing the deposition of new collagen and resulting in improved tensile strength of the anastomosis . Previous pathologist‐blinded studies have clearly shown significantly less inflammation during nitinol compression anastomosis than with circular stapled anastomosis .…”

Histopathologic Advantages of Compression Ring Anastomosis Healing as Compared With Stapled Anastomosis in a Porcine Model

“…[14][15][16] Briefly, through a 6-cm midline laparotomy, the proximal rectum was transected at 20 cm from the anal verge using a linear cutting 75-mm normal tissue thickness stapler without disruption of the blood supply from the mesentery and without rectal mobilization. These studies were approved by the Washington University Animal studies Committee and Department of Comparative medicine.…”

“…3,5 an inflammatory response occurs, characterized by a foreign body granulomatous reaction at the site of the anastomosis. 9,11,13 Recent reports in both animal [14][15][16] and human [17][18][19][20][21] studies have suggested that the compression devices safely and efficiently facilitate the intestinal anastomosis. [6][7][8] Compression anastomosis has been practiced using a variety of devices during the last 150 years.…”

Healing of Ileocolic Nitinol Compression Anastomosis

“…The first was a double-loop SMA clip (Hand CAC 30; NiTi Surgical Solutions, Netanya, Israel) aimed for side-to-side anastomosis. [18][19][20][21] Then, SMA were also used as compression elements in anastomotic rings (Endo-CAR 27 [NiTi]/ColonRing™ [novoGI, Atlanta, GA]) used for the construction of end-to-end colorectal anastomoses in animals [22][23][24] and in humans. [25][26][27][28][29][30][31] The aim of this study was to develop a large animal model of subtotal colectomy using nitinol compression anastomosis to simulate the unique healing properties and course following the connection of these different bowel segments, as well as the physiological consequences of subtotal colectomy.…”