Endoscopic Circumferential Esophageal Mucosectomy in a Porcine Model: An Assessment of Technical Feasibility, Safety, and Outcome

Background and Study Aims: Endoscopic mucosectomy has been performed for early cancers and dysplastic lesions ≤ 2 cm in diameter. The feasibility and safety of mucosectomy for circumferential lesions of the esophagus is uncertain. The aim of this study was to determine the technical feasibility, as well as the short and long-term complication rates, with circumferential endoscopic mucosectomy of the distal esophagus in the pig.

Materials and Methods: Circumferential endoscopic mucosectomy of the distal 3 cm of the esophagus was performed in four pigs, using a cap mucosectomy device. The animals were sacrificed after 30, 50, 70, and 90 days to assess mucosal regeneration and stricture formation.

Results: The procedure time for circumferential endoscopic mucosectomy was 15 - 30 min. Circumferential endoscopic mucosectomy was technically feasible and without short-term complications. Videotapes of all resections were reviewed to ensure that complete removal of the mucosa was achieved. All mucosectomy specimens underwent histological evaluation. The specimens included the mucosa alone in three of the pigs. Some of the specimens in the fourth pig included a superficial layer of muscularis propria. This pig failed to thrive. Macroscopic examination of the dissected esophageal specimens from the healthy pigs revealed a well-healed, normal-appearing esophagus, whereas a stenosis of 4 × 10 mm was observed in the distal esophagus of the pig that failed to thrive.

Conclusions: Circumferential endoscopic mucosectomy of the porcine distal esophagus is feasible and safe. An adequate submucosal saline cushion is essential to prevent stenosis due to deep injury.

References

• 1 Tada M, Murata M, Murakami F, et al. Development of the strip-off biopsy (in Japanese with English abstract).  Gastroenterol Endosc. 1984;  26 833-839
• 2 Chen Y J, Lee M D, Chen P H. Diagnosis and treatment of superficial oesophageal carcinoma.  J Gastroenterol Hepatol. 1997;  12 778-784
• 3 Karita M, Tada M, Okita K. The successive strip biopsy partial resection technique for large early gastric and colon cancers.  Gastrointest Endosc. 1992;  38 174-178
• 4 Noda N, Kodama T, Atsumi M, et al. Possibilities and limitations of endoscopic resection for early gastric cancer.  Endoscopy. 1997;  29 361-365
• 5 Yasuda K. Endoscopic ultrasonic probes and mucosectomy for early gastric carcinoma.  Gastrointest Endosc. 1996;  43 529-531
• 6 Lee D K, Lee S W, Kwon S O, et al. Endoscopic mucosectomy using an esophageal variceal ligation device for minute gastric cancer.  Endoscopy. 1996;  28 386-389
• 7 Takeshita K, Tani M, Inoue H, et al. Endoscopic treatment of early oesophageal or gastric cancer.  Gut. 1997;  40 123-127
• 8 Gostout C J, Conio M, Batts K. Endoscopic circumferential esophageal mucosectomy in a porcine model: a pilot study (abstract).  Gastrointest Endosc. 1999;  49 AB 124
• 9 Sampliner R E. Ablative therapies for the columnar-lined esophagus.  Gastroenterol Clin North Am. 1997;  26 685-689
• 10 Johan W, Luis W, Janssen J, et al. Argon plasma coagulation (APC) in gastroenterology: experimental and clinical experiences.  Eur J Gastroenterol Hepatol. 1997;  9 581-587
• 11 Grund K E, Storek D, Farm G. Endoscopic argon plasma coagulation (APC): first clinical experiences in flexible endoscopy.  Endosc Surg. 1994;  2 42-46
• 12 Bown S G, Millson C E. Photodynamic therapy in gastroenterology.  Gut. 1997;  41 5-7
• 13 Conio M, Rajan E, Sorbi D, et al. The durability of different solutions injected submucosally in a porcine model (abstract).  Gastrointest Endosc. 2000;  51 AB99
• 14 De Palma G, Caiazzo C, Di Matteo E, et al. Endoscopic treatment of sessile rectal adenomas: comparison of Nd:YAG laser therapy and injection assisted piecemeal polypectomy.  Gastrointest Endosc. 1995;  41 553-556
• 15 Shirai M, Nakamura T, Matsuda A, et al. Safer colonoscopic polypectomy with local submucosal injection of hypertonic saline-epinephrine solution.  Am J Gastroenterol. 1994;  89 334-338
• 16 Ishi H, Tatsuta M, Kitamura S, et al. Endoscopic resection of large sessile colorectal polyps using a submucosal saline injection technique.  Hepatogastroenterology. 1997;  44 698-702
• 17 Torii A, Sakai M, Kajiyama T, et al. Endoscopic aspiration mucosectomy as curative endoscopic surgery: analysis of 24 cases of early gastric cancer.  Gastrointest Endosc. 1995;  42 475-479
• 18 Tada M, Inoue H, Yabata E, et al. Feasibility of the transparent cap-fitted colonoscope for screening and mucosal resection.  Dis Colon Rectum. 1997;  40 618-621
• 19 Moreira L F, Kamikawa Y, Naomoto Y, et al. Endoscopic mucosal resection for superficial carcinoma and high-grade dysplasia of the esophagus.  Surg Laparosc Endosc. 1995;  5 171-175