Feasibility and safety of third-space endoscopic full-thickness resection in ex vivo and in vivo porcine models

Osamu Goto; Motoki Sasaki; Teppei Akimoto; Atsushi Tatsuguchi; Mitsuru Kaise; Katsuhiko Iwakiri; Naohisa Yahagi

doi:10.1055/a-0858-2210

Endoscopy International Open, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · Endoscopy 2019; 07(04): E471-E476
DOI: 10.1055/a-0858-2210

Original article

Feasibility and safety of third-space endoscopic full-thickness resection in ex vivo and in vivo porcine models

Authors

Osamu Goto

¹Department of Gastroenterology, Nippon Medical School, Tokyo, Japan

²Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University, School of Medicine, Tokyo, Japan
Motoki Sasaki

²Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University, School of Medicine, Tokyo, Japan
Teppei Akimoto

¹Department of Gastroenterology, Nippon Medical School, Tokyo, Japan

²Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University, School of Medicine, Tokyo, Japan
Atsushi Tatsuguchi

¹Department of Gastroenterology, Nippon Medical School, Tokyo, Japan
Mitsuru Kaise

¹Department of Gastroenterology, Nippon Medical School, Tokyo, Japan
Katsuhiko Iwakiri

¹Department of Gastroenterology, Nippon Medical School, Tokyo, Japan
Naohisa Yahagi

²Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University, School of Medicine, Tokyo, Japan

Abstract

Background and study aims Endoscopic full-thickness resection (EFTR) involves several technical issues that need to be addressed. We devised a novel technique termed third-space EFTR and investigated its feasibility and safety in animal models.

Methods Third-space EFTR was performed in three isolated porcine stomachs (ex vivo) and four live pigs (in vivo, 1-week survival). The technique involved a circumferential mucosal incision, submucosal tunnelling on the proximal side, endoscopic suturing of the surrounding mucosa, a circumferential seromuscular incision in the submucosal tunnel, transoral retrieval and entry site closure of the tunnel. The technical outcomes were investigated.

Results In the ex vivo study, the procedure was successfully completed with R0 resection. In the in vivo study, the procedure was completed in all pigs; however, R0 resection failed in one pig owing to snaring resection. All pigs survived without severe adverse events.

Conclusions Our findings indicate that third-space EFTR is feasible and safe. This technique may be useful as a minimally invasive endoscopic option for reliable treatment of small gastric submucosal tumours.

Volltext

Referenzen

References
1 Zhou PH, Yao LQ, Qin XY. et al. Endoscopic full-thickness resection without laparoscopic assistance for gastric submucosal tumors originated from the muscularis propria. Surg Endosc 2011; 25: 2926-2931
2 Shi Q, Chen T, Zhong YS. et al. Complete closure of large gastric defects after endoscopic full-thickness resection, using endoloop and metallic clip interrupted suture. Endoscopy 2013; 45: 329-334
3 Ye LP, Zhang Y, Luo DH. et al. Safety of endoscopic resection for upper gastrointestinal subepithelial tumors originating from the muscularis propria layer: an analysis of 733 tumors. Am J Gastroenterol 2016; 111: 788-796
4 Kantsevoy SV, Bitner M, Mitrakov AA. et al. Endoscopic suturing closure of large mucosal defects after endoscopic submucosal dissection is technically feasible, fast, and eliminates the need for hospitalization (with videos). Gastrointest Endosc 2014; 79: 503-507
5 Schmidt A, Bauder M, Riecken B. et al. Endoscopic full-thickness resection of gastric subepithelial tumors: A single-center series. Endoscopy 2015; 47: 154-158
6 Mori H, Kobara H, Fujihara S. et al. Feasibility of pure EFTR using an innovative new endoscopic suturing device: the double-arm-bar suturing system (with video). Surg Endosc 2014; 28: 683-690
7 Inoue H, Ikeda H, Hosoya T. et al. Submucosal endoscopic tumor resection for subepithelial tumors in the esophagus and cardia. Endoscopy 2012; 44: 225-230
8 Xu MD, Cai MY, Zhou PH. et al. Submucosal tunneling endoscopic resection: a new technique for treating upper gastrointestinal submucosal tumors originating from the muscularis propria layer. Gastrointest Endosc 2012; 75: 195-199
9 Li QL, Chen WF, Zhang C. et al. Clinical impact of submucosal tunneling endoscopic resection for the treatment of gastric submucosal tumors originating from the muscularis propria layer (with video). Surg Endosc 2015; 29: 3640-3646
10 Yahagi N, Uraoka T, Ida Y. et al. Endoscopic submucosal dissection using the flex and the dual knives. Techn Gastrointest Endosc 2011; 13: 74-78
11 Goto O, Sasaki M, Akimoto T. et al. Endoscopic hand-suturing for defect closure after gastric endoscopic submucosal dissection: a pilot study in animals and in humans. Endoscopy 2017; 49: 792-797
12 Inoue H, Minami H, Kobayashi Y. et al. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy 2010; 42: 265-271
13 Oyama T. Counter traction makes endoscopic submucosal dissection easier. Clin Endosc 2012; 45: 375-378
14 Sumiyama K, Gostout CJ, Rajan E. et al. Submucosal endoscopy with mucosal flap safety valve. Gastrointest Endosc 2007; 65: 688-694
15 Schmidt A, Beyna T, Schumacher B. et al. Colonoscopic full-thickness resection using an over-the-scope device: a prospective multicentre study in various indications. Gut 2018; 67: 1280-1289