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DOI: 10.1055/s-0028-1103482
© Georg Thieme Verlag KG Stuttgart · New York
Novel endoscopic application of a new flexible-fiber CO2 laser for esophageal mucosal ablation in a porcine model
Publikationsverlauf
submitted 6 June 2008
accepted after revision 17 October 2008
Publikationsdatum:
12. Februar 2009 (online)
![](https://www.thieme-connect.de/media/endoscopy/200902/lookinside/thumbnails/10.1055-s-0028-1103482-1.jpg)
Background and study aims: The CO2 laser is a surgical tool that is widely used because of its predictable penetration depth and minimal collateral damage due to efficient absorption of CO2 laser energy by tissue water. Until recently, endoscopic use was limited by lack of an efficient, flexible delivery system. The aim of the current study was to evaluate the performance, efficacy, and safety of a novel, photonic band-gap CO2 laser configured for esophageal mucosal ablation.
Materials and methods: This was an endoscopic experimental study in a porcine survival model. Initial evaluation was done on ex vivo tissue followed by endoscopic studies at 7-, 10-, 15-, and 20-W power and at 0-, 1-, 2-, 5-, and 10-mm distances, using continuous and pulsed currents, to determine optimal performance settings. In an IACUC-approved protocol, six pigs underwent circumferential ablation of the distal 6 cm of the esophagus at 10W continuous current. The animals were monitored for 2 or 4 weeks to evaluate delayed effects. Prior to euthanasia, the proximal esophagus was ablated to evaluate the homogeneity of ablation and depth of injury immediately after single and repeat ablation.
Results: The animals resumed normal diets within 24 hours and experienced no dysphagia or weight loss. Pathology at 2 and 4 weeks revealed complete re-epithelialization with minimal histologic injury. A single application of the laser produced complete transepithelial ablation of a mean of 83.3 % of the surface area (range 55 % – 100 %); depth of injury was to the muscularis mucosa in five pigs and to the superficial submucosa in one pig. With ablation, sloughing, and re-ablation, a mean of 95 % transepithelial ablation was achieved (range 80 % –100 %) with similar depth of injury.
Conclusions: Using a novel, flexible CO2 laser, homogeneous ablation was achieved with predictable penetration and minimal deep tissue injury. These results warrant further evaluation of the laser in Barrett’s esophagus, as it may overcome the limitations of current technologies including perforation, stricture, and inhomogeneity.
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S. Anandasabapathy, MD
Division of Gastroenterology
The Mount Sinai Medical Center
One Gustave L. Levy Place
New York
NY 10029
USA
Fax: 212-849-2574
eMail: Sharmila.anandasabapathy@mountsinai.org