Feasibility and safety of endoscopic full-thickness esophageal wall resection and defect closure: a prospective long-term survival animal study.
BACKGROUND
The first experiences with endoscopic closure of esophageal perforations in animal survival studies encouraged us to extend these procedures to full-thickness resections of pieces of the esophageal wall (FTEW).


OBJECTIVE
To learn the feasibility, safety, and long-term effects of FTEW removal and defect closure.


METHODS
Feasibility animal study.


METHODS
Approved animal facility.


METHODS
Twelve pigs were used for 3-month survival studies, autopsy, and histologic examination. Resection of a 2-cm piece of wall was performed with needle-knife and forceps/snare. Closure was performed by using prototype endoscopic suturing.


METHODS
Feasibility and complication assessment of this new endoscopic method.


RESULTS
There were no complications relating to incision, resection, or closure. All pigs recovered quickly. In 2 animals a larger piece of wall causing a larger defect was removed, resulting in much air penetrating into the mediastinum, causing difficult ventilation. This was resolved with thoracic drain. In 3 of 12 animals a toxic substance slipped into the mediastinum, resulting in an abscess in 1 pig and misfire of an anchor as a result of obscured vision. This caused temporary illness of the animal but not death. Autopsy and histologic study confirmed no mediastinitis and well-healed scars in all but one.


CONCLUSIONS
Animal study.


CONCLUSIONS
FTEW has proven to be feasible. Long-term survival demonstrated no mediastinitis and only 1 abscess after contamination of the mediastinum. These first experiences encourage further animal studies because the prospect of endoscopic full-thickness removal of esophageal lesions in patients might be very advantageous.
Fritscher-Ravens
Annette
A
Homerton University Hospital, London, United Kingdom. fri.rav@btopenworld.com
Cuming
Tamzin
T
Jacobsen
Bjorn
B
Seehusen
Frauke
F
Ghanbari
Amir
A
Kahle
Erich
E
von Herbay
Axel
A
Koehler
Peter
P
Milla
Peter
P
D000818:Animals; D016629:Esophagectomy / Q000379:methods*; D004945:Esophagoscopy / Q000009:adverse effects; D005240:Feasibility Studies; D023421:Models, Animal; D011446:Prospective Studies; D013536:Suture Techniques; D013552:Swine; D016896:Treatment Outcome