title: Endoscopic mucosal resection using a grasp-and-snare technique.
abstract: OBJECTIVE
  Endoscopic mucosal resection (EMR) is a minimally invasive method for en bloc removal of superficial gastrointestinal lesions. The aim of this study was to evaluate the feasibility of a novel grasp-and-snare EMR technique.
  
  
  METHODS
  In 10 domestic pigs, gastric lesions of approximately 3 cm were marked using electrocautery. EMR was performed using a double-channel endoscope. A novel tissue anchor was used through one channel, and a monofilament snare through the other. After submucosal injection, a circumferential mucosal incision was created. The tissue-anchoring device was then advanced through the open snare and anchored into the submucosal layer. The tissue-anchoring device was partly retracted into the endoscope and the snare was positioned into the circular incision. The snare was subsequently closed and the specimen resected by applying high-frequency electrocautery.
  
  
  RESULTS
  Mean time to perform EMR was 32.4 minutes (range 22-41 minutes, SD 6.3). EMR yielded specimens that ranged in area from 2.7 cm (minor axis) by 2.8 cm (major axis) to 4.0 cm by 4.2 cm (mean area 9.36 cm(2); range 5.94-13.19 cm(2); SD +/- 2.50). Complete en bloc resection including all electrocautery markings was achieved in 9/10 cases. In one case, resection was achieved in two steps. One gastric wall perforation occurred. No other adverse events were observed.
  
  
  CONCLUSIONS
  Grasp-and-snare EMR is feasible in an animal model. The technique can be performed efficiently compared with standard methods. To avoid perforation, caution is needed to ensure that tissue anchor needles are placed within and not deeper than the submucosal layer prior to tissue retraction.
authors.affiliation: Department of Gastroenterology, Hepatology, and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany. renteln@gmx.net
authors.forename: D
authors.initials: D
authors.lastname: von Renteln
authors.forename: A
authors.initials: A
authors.lastname: Schmidt
authors.forename: M C
authors.initials: MC
authors.lastname: Vassiliou
authors.forename: H-U
authors.initials: HU
authors.lastname: Rudolph
authors.forename: K
authors.initials: K
authors.lastname: Caca
mesh_terms: D000818:Animals; D005240:Feasibility Studies; D005260:Female; D005753:Gastric Mucosa / Q000601:surgery*; D005773:Gastroscopy / Q000379:methods*; D023421:Models, Animal; D010865:Pilot Projects; D053441:Suture Anchors; D013552:Swine