title: Endoscopic full-thickness resection of gastric lesions using a novel grasp-and-snare technique: evaluation in a porcine survival model.
abstract: BACKGROUND
  Endoscopic full-thickness resection (EFTR) is a less-invasive method of en bloc removal of gastrointestinal tumors. In a previous nonsurvival animal experiment, the feasibility of a novel grasp-and-snare EFTR technique using a prototype tissue-lifting device was demonstrated. The objective of this study was to evaluate the safety and outcomes of this EFTR method in a porcine survival model.
  
  
  METHODS
  EFTR of model stomach tumors was performed in seven pigs using a double-channel endoscope with a prototype tissue-lifting device through one channel and snare through the other. The lifting device was advanced through the snare loop and anchored to the gastric wall adjacent the model tumor. The lifting device was then partially retracted into the endoscope, causing the target tissue, including tumor, to evert into the gastric lumen. The open snare was then placed beyond the tumor around uninvolved gastric tissue. Resection was performed by delivering an electrosurgical current through the snare. EFTR defects were closed by using tissue anchors. After an intended 10-day observation period, the pigs were euthanized and necropsy was performed.
  
  
  RESULTS
  All seven resections were successful with negative gross margins. No immediate complications occurred. Two defect closures failed during the early postoperative period, leading to infectious complications. The remaining intact closures were complicated by adjacent ulcers, one of which resulted in hemorrhage.
  
  
  CONCLUSIONS
  Endoscopic full-thickness resection of gastric lesions using the grasp-and-snare technique is feasible in pigs. In this experiment, complications related to closure were significant. Further evaluation and modification of closure technique is necessary before studying this method of EFTR in humans.
authors.affiliation: Division of Gastroenterology, University of Michigan Medical Center, 3912 Taubman Center, SPC 5362, Ann Arbor, MI 48109, USA. badihe@med.umich.edu
authors.forename: B Joseph
authors.initials: BJ
authors.lastname: Elmunzer
authors.forename: Akbar K
authors.initials: AK
authors.lastname: Waljee
authors.forename: Jason R
authors.initials: JR
authors.lastname: Taylor
authors.forename: Gail M
authors.initials: GM
authors.lastname: Rising
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Trunzo
authors.forename: Grace H
authors.initials: GH
authors.lastname: Elta
authors.forename: James M
authors.initials: JM
authors.lastname: Scheiman
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Ponsky
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Marks
authors.forename: Richard S
authors.initials: RS
authors.lastname: Kwon
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D005260:Female; D005773:Gastroscopy / Q000379:methods*; D013274:Stomach Neoplasms / Q000601:surgery*; D013536:Suture Techniques; D013552:Swine