BACKGROUND: Widespread EMR is a novel technique for resection of large areas of mucosa as a single bloc. Large lesion size (>2 cm) is a recognized limitation of current EMR techniques. This study assessed the technical feasibility, efficacy, and safety of widespread EMR in a porcine model. METHODS: Widespread EMR was performed in 6 pigs. A submucosal fluid cushion was created in the distal esophagus by using a 0.83% solution of hydroxypropyl methylcellulose. A mucosal strip 5 cm in length and including at least 50% of the luminal circumference was marginated by using a prototype cutting device. The proximal end of the mucosa was stripped from the submucosa by using a grasping forceps. The distal end was snare resected. Resected tissue was assessed histologically. Endoscopy was repeated at weeks 1 and 6. At week 6, a second widespread EMR of the mucosa on the wall opposite the initial resection was attempted to create a full circumferential resection. RESULTS: Widespread EMR was completed in all animals. The esophagus was denuded of mucosa in 5-cm lengths that included 50% of the circumference of the lumen. No procedure-related complication was observed. Histologic assessment demonstrated that the resection specimen included mucosa and submucosa but not muscularis propria. Endoscopy at 1 week revealed mucosal regrowth in two animals and ulceration in 4. At week 6, regrowth of mucosa was noted in all animals. The second wide EMR proved to be technically difficult and was associated with perforation, peri-esophageal abscess, and stricture formation. CONCLUSIONS: Wide EMR appears to be technically feasible for removal of large areas of mucosa. Mucosal strips 5 cm long that included over 50% of the luminal circumference were resected safely. Resection was followed by complete regrowth of the mucosa. However, a second wide EMR to create a circumferential resection proved to be technically difficult and unsafe.
BACKGROUND: Widespread EMR is a novel technique for resection of large areas of mucosa as a single bloc. Large lesion size (>2 cm) is a recognized limitation of current EMR techniques. This study assessed the technical feasibility, efficacy, and safety of widespread EMR in a porcine model. METHODS: Widespread EMR was performed in 6 pigs. A submucosal fluid cushion was created in the distal esophagus by using a 0.83% solution of hydroxypropyl methylcellulose. A mucosal strip 5 cm in length and including at least 50% of the luminal circumference was marginated by using a prototype cutting device. The proximal end of the mucosa was stripped from the submucosa by using a grasping forceps. The distal end was snare resected. Resected tissue was assessed histologically. Endoscopy was repeated at weeks 1 and 6. At week 6, a second widespread EMR of the mucosa on the wall opposite the initial resection was attempted to create a full circumferential resection. RESULTS: Widespread EMR was completed in all animals. The esophagus was denuded of mucosa in 5-cm lengths that included 50% of the circumference of the lumen. No procedure-related complication was observed. Histologic assessment demonstrated that the resection specimen included mucosa and submucosa but not muscularis propria. Endoscopy at 1 week revealed mucosal regrowth in two animals and ulceration in 4. At week 6, regrowth of mucosa was noted in all animals. The second wide EMR proved to be technically difficult and was associated with perforation, peri-esophageal abscess, and stricture formation. CONCLUSIONS: Wide EMR appears to be technically feasible for removal of large areas of mucosa. Mucosal strips 5 cm long that included over 50% of the luminal circumference were resected safely. Resection was followed by complete regrowth of the mucosa. However, a second wide EMR to create a circumferential resection proved to be technically difficult and unsafe.
Authors: Tobias Lingenfelder; Klaus Fischer; Moritz G Sold; Stefan Post; Markus D Enderle; Georg F B A Kaehler Journal: Surg Endosc Date: 2009-04-03 Impact factor: 4.584
Authors: Stavros N Stavropoulos; David J Desilets; Karl-Hermann Fuchs; Christopher J Gostout; Gregory Haber; Haruhiro Inoue; Michael L Kochman; Rani Modayil; Thomas Savides; Daniel J Scott; Lee L Swanstrom; Melina C Vassiliou Journal: Surg Endosc Date: 2014-06-17 Impact factor: 4.584
Authors: Marc A Ward; Matt Gitelis; Lava Patel; Yalini Vigneswaran; Joann Carbray; Michael B Ujiki Journal: Surg Endosc Date: 2016-11-17 Impact factor: 4.584
Authors: Ahmed M Sharata; Christy M Dunst; Radu Pescarus; Eran Shlomovitz; Aaron J T Wille; Kevin M Reavis; Lee L Swanström Journal: J Gastrointest Surg Date: 2014-09-03 Impact factor: 3.452
Authors: Lee L Swanstrom; Richard Kozarek; Pankaj J Pasricha; Steven Gross; Desmond Birkett; Per-Ola Park; Vahid Saadat; Richard Ewers; Paul Swain Journal: J Gastrointest Surg Date: 2005-11 Impact factor: 3.452