Circumferential endoscopic mucosal resection in the swine esophagus assisted by a cap attachment.
BACKGROUND
The feasibility and safety of piecemeal, circumferential endoscopic mucosal resection of the distal esophagus are unknown. This study assessed this procedure in a porcine model.


METHODS
Different techniques of endoscopic mucosal resection were tested in Phase I of the study in two animals. During Phase II, 6 pigs underwent piecemeal cap-assisted EMR of the distal esophagus. The mucosa of one half of the circumference of the distal 5 cm of the esophagus was resected. After complete endoscopic re-epithelization, endoscopic mucosal resection was performed on the remaining unresected hemi-circumference. Healing was promoted by daily administration of lansoprazole and documented by weekly endoscopy.


METHODS
In Phase I, one perforation occurred during initial testing of cap-assisted endoscopic mucosal resection. Subsequent cap-assisted endoscopic mucosal resection led to homogenous and uniform piecemeal resection of mucosa. In Phase II, circumferential cap-assisted endoscopic mucosal resection was performed in 6 pigs without perforation or major bleeding. Complete endoscopic re-epithelization occurred over a mean of 3.6 weeks (range: 3-5). Strictures developed in 3 animals.


CONCLUSIONS
Piecemeal circumferential cap-assisted endoscopic mucosal resection is safe and feasible in the normal swine esophagus. Proper technique for cap-assisted piecemeal endoscopic mucosal resection is necessary to minimize the risk of perforation. Procedural complications include esophageal stricture formation.
Kamler
Jan P
JP
Division of Gastroenterology, University of California-San Diego, USA.
Borsatto
Richardo
R
Binmoeller
Kenneth F
KF
D000818:Animals; D004195:Disease Models, Animal; D016145:Endoscopy, Digestive System / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D004935:Esophageal Diseases / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery*; D004947:Esophagus / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D008297:Male; D009092:Mucous Membrane / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D013552:Swine; D014945:Wound Healing / Q000502:physiology