title: En bloc esophageal mucosectomy for concentric circumferential mucosal resection (with video).
abstract: BACKGROUND
  With conventional EMR, specimens are fragmented, metaplasia may be left behind, and invasive lesions could be missed because of incomplete sampling. Concentric subtotal esophageal mucosectomy would address these limitations.
  
  
  OBJECTIVE
  To examine en bloc esophageal mucosectomy (EEM).
  
  
  METHODS
  A prospective case series.
  
  
  METHODS
  An academic hospital.
  
  
  METHODS
  Nine swine.
  
  
  METHODS
  Conventional EMR was performed in the proximal esophagus. The submucosal space was entered, and the distal two thirds of the esophageal mucosa was freed with blunt dissection. A snare was threaded over the column of mucosa to the gastroesophageal junction. The column was resected, and the mucosa was retrieved.
  
  
  METHODS
  Clinical examination, follow-up endoscopy, necropsy, and gross and histopathologic examination.
  
  
  RESULTS
  EEM permitted subtotal esophageal mucosectomy in 9 of 9 swine (tissue specimens removed ranged 9-15 cm in length). The mean procedure duration was 110 minutes. In the survival series, 4 of 4 swine thrived after surgery, for 9 to 13 days. At 9 days, there was no evidence of a perforation, stricture, or leak. At 13 days, 2 swine had a mild proximal stricture, which was easily traversed with a 9.8-mm gastroscope. On necropsy, the mediastinal and thoracic cavities were unremarkable in 3 of 4 swine. One swine was found to have a contained abscess containing cellulose, presumably secondary to ingestion of wood-chip bedding material postoperatively. Reepithelialization was present on histologic examination.
  
  
  CONCLUSIONS
  An animal study.
  
  
  CONCLUSIONS
  EEM is feasible and enabled concentric subtotal esophageal mucosal resection. The technique could completely and circumferentially excise intramucosal lesions. Longer follow-up and larger studies are needed to evaluate infection, stricture, and safety.
authors.affiliation: Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
authors.forename: Field F
authors.initials: FF
authors.lastname: Willingham
authors.forename: Denise W
authors.initials: DW
authors.lastname: Gee
authors.forename: Patricia
authors.initials: P
authors.lastname: Sylla
authors.forename: Gregory Y
authors.initials: GY
authors.lastname: Lauwers
authors.forename: David W
authors.initials: DW
authors.lastname: Rattner
authors.forename: William R
authors.initials: WR
authors.lastname: Brugge
mesh_terms: D000818:Animals; D001707:Biopsy, Needle; D004195:Disease Models, Animal; D004935:Esophageal Diseases / Q000473:pathology / Q000601:surgery; D016629:Esophagectomy / Q000379:methods; D004945:Esophagoscopy / Q000379:methods*; D005240:Feasibility Studies; D007150:Immunohistochemistry; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D009092:Mucous Membrane / Q000601:surgery*; D011336:Probability; D011897:Random Allocation; D012680:Sensitivity and Specificity; D013552:Swine; D014741:Video Recording