BACKGROUND: The first experiences with endoscopic closure of esophageal perforations in animal survival studies encouraged us to extend these procedures to full-thickness resections of pieces of the esophageal wall (FTEW). OBJECTIVE: To learn the feasibility, safety, and long-term effects of FTEW removal and defect closure. DESIGN: Feasibility animal study. SETTING: Approved animal facility. INTERVENTIONS: Twelve pigs were used for 3-month survival studies, autopsy, and histologic examination. Resection of a 2-cm piece of wall was performed with needle-knife and forceps/snare. Closure was performed by using prototype endoscopic suturing. MAIN OUTCOME MEASUREMENTS: Feasibility and complication assessment of this new endoscopic method. RESULTS: There were no complications relating to incision, resection, or closure. All pigs recovered quickly. In 2 animals a larger piece of wall causing a larger defect was removed, resulting in much air penetrating into the mediastinum, causing difficult ventilation. This was resolved with thoracic drain. In 3 of 12 animals a toxic substance slipped into the mediastinum, resulting in an abscess in 1 pig and misfire of an anchor as a result of obscured vision. This caused temporary illness of the animal but not death. Autopsy and histologic study confirmed no mediastinitis and well-healed scars in all but one. LIMITATION: Animal study. CONCLUSION: FTEW has proven to be feasible. Long-term survival demonstrated no mediastinitis and only 1 abscess after contamination of the mediastinum. These first experiences encourage further animal studies because the prospect of endoscopic full-thickness removal of esophageal lesions in patients might be very advantageous.
BACKGROUND: The first experiences with endoscopic closure of esophageal perforations in animal survival studies encouraged us to extend these procedures to full-thickness resections of pieces of the esophageal wall (FTEW). OBJECTIVE: To learn the feasibility, safety, and long-term effects of FTEW removal and defect closure. DESIGN: Feasibility animal study. SETTING: Approved animal facility. INTERVENTIONS: Twelve pigs were used for 3-month survival studies, autopsy, and histologic examination. Resection of a 2-cm piece of wall was performed with needle-knife and forceps/snare. Closure was performed by using prototype endoscopic suturing. MAIN OUTCOME MEASUREMENTS: Feasibility and complication assessment of this new endoscopic method. RESULTS: There were no complications relating to incision, resection, or closure. All pigs recovered quickly. In 2 animals a larger piece of wall causing a larger defect was removed, resulting in much air penetrating into the mediastinum, causing difficult ventilation. This was resolved with thoracic drain. In 3 of 12 animals a toxic substance slipped into the mediastinum, resulting in an abscess in 1 pig and misfire of an anchor as a result of obscured vision. This caused temporary illness of the animal but not death. Autopsy and histologic study confirmed no mediastinitis and well-healed scars in all but one. LIMITATION: Animal study. CONCLUSION: FTEW has proven to be feasible. Long-term survival demonstrated no mediastinitis and only 1 abscess after contamination of the mediastinum. These first experiences encourage further animal studies because the prospect of endoscopic full-thickness removal of esophageal lesions in patients might be very advantageous.
Authors: Georg O Spaun; Christy M Dunst; Brittany N Arnold; Danny V Martinec; Maria A Cassera; Lee L Swanström Journal: J Gastrointest Surg Date: 2010-08-19 Impact factor: 3.452
Authors: Daniel von Renteln; Thomas Rösch; Thomas Kratt; Ulrike W Denzer; Muhammad El-Masry; Guido Schachschal Journal: Dig Dis Sci Date: 2012-02-28 Impact factor: 3.199
Authors: Henry Córdova; Raúl San José Estépar; Antonio Rodríguez-D'Jesús; Graciela Martínez-Pallí; Pedro Arguis; Cristina Rodríguez de Miguel; Ricard Navarro-Ripoll; Juan M Perdomo; Miriam Cuatrecasas; Josep Llach; Kirby G Vosburgh; Gloria Fernández-Esparrach Journal: Gastrointest Endosc Date: 2013-01 Impact factor: 9.427