Widespread EMR: a new technique for removal of large areas of mucosa.
BACKGROUND
Widespread EMR is a novel technique for resection of large areas of mucosa as a single bloc. Large lesion size (>2 cm) is a recognized limitation of current EMR techniques. This study assessed the technical feasibility, efficacy, and safety of widespread EMR in a porcine model.


METHODS
Widespread EMR was performed in 6 pigs. A submucosal fluid cushion was created in the distal esophagus by using a 0.83% solution of hydroxypropyl methylcellulose. A mucosal strip 5 cm in length and including at least 50% of the luminal circumference was marginated by using a prototype cutting device. The proximal end of the mucosa was stripped from the submucosa by using a grasping forceps. The distal end was snare resected. Resected tissue was assessed histologically. Endoscopy was repeated at weeks 1 and 6. At week 6, a second widespread EMR of the mucosa on the wall opposite the initial resection was attempted to create a full circumferential resection.


RESULTS
Widespread EMR was completed in all animals. The esophagus was denuded of mucosa in 5-cm lengths that included 50% of the circumference of the lumen. No procedure-related complication was observed. Histologic assessment demonstrated that the resection specimen included mucosa and submucosa but not muscularis propria. Endoscopy at 1 week revealed mucosal regrowth in two animals and ulceration in 4. At week 6, regrowth of mucosa was noted in all animals. The second wide EMR proved to be technically difficult and was associated with perforation, peri-esophageal abscess, and stricture formation.


CONCLUSIONS
Wide EMR appears to be technically feasible for removal of large areas of mucosa. Mucosal strips 5 cm long that included over 50% of the luminal circumference were resected safely. Resection was followed by complete regrowth of the mucosa. However, a second wide EMR to create a circumferential resection proved to be technically difficult and unsafe.
Division of Gastroenterology and Hepatology, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA.
Elizabeth
E
Rajan
Christopher J
CJ
Gostout
Arnaldo B
AB
Feitoza
Olga N
ON
Leontovich
Lori J
LJ
Herman
Lawrence J
LJ
Burgart
Sydney
S
Chung
Peter B
PB
Cotton
Robert H
RH
Hawes
Anthony N
AN
Kalloo
Sergey V
SV
Kantsevoy
Pankaj J
PJ
Pasricha
D000818:Animals; D004724:Endoscopy / Q000379:methods*; D004947:Esophagus / Q000473:pathology / Q000601:surgery*; D041981:Gastrointestinal Tract / Q000601:surgery; D065347:Hypromellose Derivatives; D008747:Methylcellulose / Q000031:analogs & derivatives*; D009092:Mucous Membrane / Q000473:pathology / Q000601:surgery; D012086:Reoperation; D013552:Swine
D065347:Hypromellose Derivatives; D008747:Methylcellulose