title: Extensive circumferential endoscopic mucosal resection with a new rigid esophagoscope: an animal study.
abstract: OBJECTIVE
  Current endoscopic mucosal resection techniques are suboptimal for large circumferential mucosal resections intended to treat Barrett mucosa with multicentric foci of high-grade intraepithelial neoplasia or early adenocarcinomas. A rigid modified endoscope was developed for extended endoscopic mucosal resection in the esophagus. This pilot animal study investigated the feasibility of circumferential endoscopic mucosal resections of different lengths in the sheep esophagus.
  
  
  METHODS
  Circumferential esophageal endoscopic mucosal resections of 2.2 cm (n = 6), 3.3 cm (n = 6), 4.4 cm (n = 7), and 5.5 cm (n = 5) were performed in 24 sheep. Circumferential resections consisted of two opposite hemicircumferential mucosectomies. Animals were followed up with endoscopic examinations at 1 week and then monthly to 6 months, or until complete re-epithelialization without stenosis eventually ensued. Strictures were treated with a single or repeated dilatations with Savary bougies.
  
  
  RESULTS
  Circumferential resections 2.2 to 5.5 cm in length were successfully performed in 23 of 24 of the animals. One perforation occurred directly after mucosectomy. Accurate depth of resection through the submucosa was obtained in 85% of the specimens. Cicatricial stenosis was controlled in 95% by bougienage.
  
  
  CONCLUSIONS
  Endoscopic mucosal resection performed with the rigid esophagoscope allowed extensive circumferential resections in a single session. There is thus potential to eradicate complete Barrett esophagus with high-grade intraepithelial neoplasia or early adenocarcinomas.
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. raphaelle.pilloud@hcuge.ch
authors.forename: Raphaelle
authors.initials: R
authors.lastname: Pilloud
authors.forename: Yves
authors.initials: Y
authors.lastname: Jaquet
authors.forename: Philippe
authors.initials: P
authors.lastname: Monnier
mesh_terms: D000818:Animals; D004867:Equipment Design; D020701:Esophagoscopes; D004945:Esophagoscopy / Q000379:methods*; D004947:Esophagus / Q000473:pathology / Q000601:surgery; D005240:Feasibility Studies; D009092:Mucous Membrane; D010865:Pilot Projects; D012756:Sheep