title: Endoscopic full-thickness resection of submucosal gastric tumors.
abstract: OBJECTIVE
  Endoscopic full-thickness resection (EFTR) is a minimally invasive method for en bloc resection of gastrointestinal lesions, such as early cancer or submucosal tumor. The aim of this pilot study was to evaluate a novel EFTR prototype device for full-thickness resection of the gastric wall containing artificial submucosal lesions.
  
  
  METHODS
  Six artificial submucosal tumors were surgically created in the gastric submucosa by implanting 8-mm cork beads in anesthetized pigs. EFTR of the lesions was attempted using a prototype device which consists of a large transparent plastic cap, loaded onto the tip of the endoscope, into which the submucosal lesion and the surrounding gastrointestinal wall can be pulled by using suction, a grasping forceps, or a dedicated anchoring device. An over-the-scope clip (OTSC) can be deployed underneath the submucosal lesion and a pre-loaded snare is used for EFTR above the OTSC.
  
  
  RESULTS
  The median procedure time was 15 min (interquartile range 11-22). Successful resection of the artificial submucosal lesion was achieved in 4/6 (67%) cases. Successful EFTR of the gastric wall was achieved in 3/6 (50%) cases. In all cases, the OTSC closed the EFTR site completely.
  
  
  CONCLUSIONS
  Gastric EFTR using the novel EFTR prototype device is feasible in a live animal model. The technique can achieve a full-thickness gastric wall and submucosal tumor resection with reliable closure of the gastric wall, but further refinements of the technique and device are necessary in order to reliably resect submucosal lesions, especially larger ones.
authors.affiliation: Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany. renteln@gmx.net
authors.forename: Daniel
authors.initials: D
authors.lastname: von Renteln
authors.forename: Thomas
authors.initials: T
authors.lastname: Rösch
authors.forename: Thomas
authors.initials: T
authors.lastname: Kratt
authors.forename: Ulrike W
authors.initials: UW
authors.lastname: Denzer
authors.forename: Muhammad
authors.initials: M
authors.lastname: El-Masry
authors.forename: Guido
authors.initials: G
authors.lastname: Schachschal
mesh_terms: D000818:Animals; D004867:Equipment Design; D005260:Female; D005743:Gastrectomy / Q000295:instrumentation / Q000379:methods; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery*; D020699:Gastroscopes; D005773:Gastroscopy / Q000295:instrumentation / Q000379:methods; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods; D023421:Models, Animal; D009374:Neoplasms, Experimental; D010865:Pilot Projects; D015203:Reproducibility of Results; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D013552:Swine; D013997:Time Factors; D016896:Treatment Outcome; D058106:Wound Closure Techniques / Q000295:instrumentation