Chemically assisted peroral endoscopic myotomy with submucosal mesna injection in a porcine model.
BACKGROUND
Peroral endoscopic myotomy (POEM) is a less invasive alternative to standard surgery for the treatment of achalasia. Previous studies have demonstrated that submucosal injections of mesna soften tissues and facilitate endoscopic submucosal dissection.


METHODS
We studied the technical feasibility of a chemically assisted POEM procedure with mesna injection (CA-POEM) in ten pigs compared with POEM with saline injection in five pigs. We also compared two dissection techniques in CA-POEM, diathermy needle knife dissection (n = 5) and balloon mechanical dissection (n = 5). A 10 cm esophageal submucosal tunnel was created with a needle knife or with balloon mechanical dissection following mesna or saline submucosal injection. Approximately 5 cm of inner circular muscle was then dissected within the tunnel. The tunnel was closed with endoclip application at the mucosal endoscopic entry point. Pigs were sacrificed one week post procedure.


RESULTS
All procedures were successful and all pigs survived for one week. Submucosal tunneling time was significantly shorter in the mesna group (363.8 sec for needle knife dissection and 294.2 sec for balloon dissection) than in the saline group (640 sec), regardless of the dissection method (p < 0.05).


CONCLUSIONS
Our study demonstrated the technical feasibility of CA-POEM.
a Department of Endoscopy, Jikei University School of Medicine , Tokyo, Japan.
Yosuke
Y
Kawahara
a Department of Endoscopy, Jikei University School of Medicine , Tokyo, Japan.
Kazuki
K
Sumiyama
a Department of Endoscopy, Jikei University School of Medicine , Tokyo, Japan.
Hisao
H
Tajiri
D000818:Animals; D004210:Dissection / Q000379:methods; D004931:Esophageal Achalasia / Q000601:surgery*; D004945:Esophagoscopy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D007267:Injections; D015080:Mesna / Q000008:administration & dosage*; D009092:Mucous Membrane; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D013552:Swine
D015080:Mesna
NOTES; POEM; animal study; mesna