BACKGROUND: The feasibility and safety of piecemeal, circumferential endoscopic mucosal resection of the distal esophagus are unknown. This study assessed this procedure in a porcine model. METHODS: Different techniques of endoscopic mucosal resection were tested in Phase I of the study in two animals. During Phase II, 6 pigs underwent piecemeal cap-assisted EMR of the distal esophagus. The mucosa of one half of the circumference of the distal 5 cm of the esophagus was resected. After complete endoscopic re-epithelization, endoscopic mucosal resection was performed on the remaining unresected hemi-circumference. Healing was promoted by daily administration of lansoprazole and documented by weekly endoscopy. OBSERVATIONS: In Phase I, one perforation occurred during initial testing of cap-assisted endoscopic mucosal resection. Subsequent cap-assisted endoscopic mucosal resection led to homogenous and uniform piecemeal resection of mucosa. In Phase II, circumferential cap-assisted endoscopic mucosal resection was performed in 6 pigs without perforation or major bleeding. Complete endoscopic re-epithelization occurred over a mean of 3.6 weeks (range: 3-5). Strictures developed in 3 animals. CONCLUSIONS: Piecemeal circumferential cap-assisted endoscopic mucosal resection is safe and feasible in the normal swine esophagus. Proper technique for cap-assisted piecemeal endoscopic mucosal resection is necessary to minimize the risk of perforation. Procedural complications include esophageal stricture formation.
BACKGROUND: The feasibility and safety of piecemeal, circumferential endoscopic mucosal resection of the distal esophagus are unknown. This study assessed this procedure in a porcine model. METHODS: Different techniques of endoscopic mucosal resection were tested in Phase I of the study in two animals. During Phase II, 6 pigs underwent piecemeal cap-assisted EMR of the distal esophagus. The mucosa of one half of the circumference of the distal 5 cm of the esophagus was resected. After complete endoscopic re-epithelization, endoscopic mucosal resection was performed on the remaining unresected hemi-circumference. Healing was promoted by daily administration of lansoprazole and documented by weekly endoscopy. OBSERVATIONS: In Phase I, one perforation occurred during initial testing of cap-assisted endoscopic mucosal resection. Subsequent cap-assisted endoscopic mucosal resection led to homogenous and uniform piecemeal resection of mucosa. In Phase II, circumferential cap-assisted endoscopic mucosal resection was performed in 6 pigs without perforation or major bleeding. Complete endoscopic re-epithelization occurred over a mean of 3.6 weeks (range: 3-5). Strictures developed in 3 animals. CONCLUSIONS: Piecemeal circumferential cap-assisted endoscopic mucosal resection is safe and feasible in the normal swine esophagus. Proper technique for cap-assisted piecemeal endoscopic mucosal resection is necessary to minimize the risk of perforation. Procedural complications include esophageal stricture formation.
Authors: Eric M Pauli; Steve J Schomisch; Joseph P Furlan; Andrea S Marks; Amitabh Chak; Richard H Lash; Jeffrey L Ponsky; Jeffrey M Marks Journal: Surg Endosc Date: 2012-06-09 Impact factor: 4.584
Authors: András Légner; Rudolf J Stadlhuber; Fumiaki Yano; Kazuto Tsuboi; Sumeet K Mittal; Richard I Rothstein; Charles J Filipi Journal: Surg Endosc Date: 2010-07-08 Impact factor: 4.584
Authors: Bart P L Witteman; Tyler J Foxwell; Sandy Monsheimer; Andres Gelrud; George M Eid; Alejandro Nieponice; Robert W O'Rourke; Toshitaka Hoppo; Nicole D Bouvy; Stephen F Badylak; Blair A Jobe Journal: J Gastrointest Surg Date: 2009-10-14 Impact factor: 3.452
Authors: Jan Bures; Marcela Kopácová; Jaroslav Kvetina; Jan Osterreicher; Zuzana Sinkorová; Zbynek Svoboda; Ilja Tachecí; Stanislav Filip; Stanislav Spelda; Martin Kunes; Stanislav Rejchrt Journal: Surg Endosc Date: 2008-12-05 Impact factor: 4.584