title: Transoral endoscopic inner layer esophagectomy: management of high-grade dysplasia and superficial cancer with organ preservation.
abstract: BACKGROUND
  Limitations of endoscopic therapies for Barrett's esophagus and superficial cancer include a compromised histological assessment, the need for surveillance, subsequent procedures, and stricture formation. Circumferential en bloc resection of the mucosa-submucosa complex followed by deployment of a biologic scaffold onto the remaining muscularis propria may address these concerns. The objective of this study was to determine technical feasibility of transoral resection of the esophageal lining.
  
  
  METHODS
  Transoral endoscopic inner layer esophagectomy was performed in ten swine. Endpoints included procedure duration, hemorrhage, number of perforations, and adequacy of resection length and depth.
  
  
  RESULTS
  Procedures were successfully completed in all animals without perioperative mortality. Procedure times averaged 179 min (range 125-320). No perforations were found, and a mean of 1.7 (0-4) interventions for hemorrhage was required. Complete longitudinal resection was achieved in nine of ten animals. Resection depth included all mucosal layers in 100% of tissue sections, the submucosal layers, SM1 in 100%, and SM2 in 96%. A portion of SM3 was adherent to the muscularis propria in 70%.
  
  
  CONCLUSIONS
  Transoral endoscopic resection of the inner esophageal layers was feasible and reproducible. This technique may facilitate a single-step definitive treatment and staging tool for early neoplastic lesions, obviating the need for esophagectomy.
authors.affiliation: Division of Thoracic and Foregut Surgery, Heart, Lung and Esophageal Surgery Institute, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Bart P L
authors.initials: BP
authors.lastname: Witteman
authors.forename: Tyler J
authors.initials: TJ
authors.lastname: Foxwell
authors.forename: Sandy
authors.initials: S
authors.lastname: Monsheimer
authors.forename: Andres
authors.initials: A
authors.lastname: Gelrud
authors.forename: George M
authors.initials: GM
authors.lastname: Eid
authors.forename: Alejandro
authors.initials: A
authors.lastname: Nieponice
authors.forename: Robert W
authors.initials: RW
authors.lastname: O'Rourke
authors.forename: Toshitaka
authors.initials: T
authors.lastname: Hoppo
authors.forename: Nicole D
authors.initials: ND
authors.lastname: Bouvy
authors.forename: Stephen F
authors.initials: SF
authors.lastname: Badylak
authors.forename: Blair A
authors.initials: BA
authors.lastname: Jobe
mesh_terms: D000818:Animals; D001471:Barrett Esophagus / Q000473:pathology / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D004945:Esophagoscopy / Q000379:methods*; D004947:Esophagus / Q000473:pathology; D005260:Female; D009092:Mucous Membrane / Q000473:pathology; D013552:Swine