title: Laparoscopic transgastric circumferential stapler-assisted vs. endoscopic esophageal mucosectomy in a porcine model.
abstract: Background and study aimsExtensive endoscopic mucosal resection (EMR) for Barrett's esophagus (BE) may lead to stenosis. Laparoscopic, transgastric, stapler-assisted mucosectomy (SAM) with the retrieval of a circumferential specimen is proposed.MethodsSAM was evaluated in two phases. The feasibility of SAM and the quality of specimens were assessed in eight animals. The mucosal healing was evaluated in a 6-week survival experiment comparing SAM (n = 6) with EMR (n = 6). The ratio of the esophageal lumen width (REL) at the resection level measured on fluoroscopy at 6 weeks divided by the width immediately after resection was compared.ResultsIn all animals, a circular mucosectomy specimen was successfully obtained, with a median area of 492 mm2(interquartile range [IQR] 426 - 573 mm2) and 941 mm2(IQR 813 - 1209 mm2) using a 21 mm and 25 mm stapler, respectively. In the survival experiments, symptomatic stenosis developed in two animals after EMR and in none after SAM. The REL was 0.27 (0.18 - 0.39) and 0.96 (0.9 - 1.04;P< 0.0001) for EMR and SAM, respectively.ConclusionsSAM provides a novel technique for en bloc mucosectomy in BE. In contrast to EMR, mucosal healing after SAM was not associated with stenosis up to 6 weeks after intervention.
authors.affiliation: Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany.|St. Claraspital AG, Departement of Surgery, Basel, Switzerland.
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Steinemann
authors.affiliation: Department of Surgery, Klinik Stephanshorn, St. Gallen, Switzerland.
authors.forename: Andreas
authors.initials: A
authors.lastname: Zerz
authors.affiliation: Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany.
authors.forename: Philip C
authors.initials: PC
authors.lastname: Müller
authors.affiliation: Department of Gastroenterology, University of Heidelberg, Heidelberg, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Sauer
authors.affiliation: Department of Gastroenterology, University of Heidelberg, Heidelberg, Germany.
authors.forename: Anja
authors.initials: A
authors.lastname: Schaible
authors.affiliation: Institute of Pathology, University of Heidelberg, Heidelberg, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Lasitschka
authors.affiliation: Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany.
authors.forename: Anne-Catherine
authors.initials: AC
authors.lastname: Schwarz
authors.affiliation: Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany.
authors.forename: Beat P
authors.initials: BP
authors.lastname: Müller-Stich
authors.affiliation: Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany.|Department of Surgery, Hospital STS Thun AG, Thun, Switzerland.
authors.forename: Georg R
authors.initials: GR
authors.lastname: Linke
mesh_terms: D000818:Animals; D000069916:Endoscopic Mucosal Resection / Q000009:adverse effects*; D000071041:Esophageal Mucosa / Q000601:surgery*; D004940:Esophageal Stenosis / Q000209:etiology*; D010535:Laparoscopy / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods*; D013270:Stomach; D013528:Surgical Staplers; D000072836:Surgical Wound / Q000150:complications*; D013552:Swine; D014945:Wound Healing