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Endoscopic mucosal resection with a cap-fitted endoscope versus freehand gastric mucosectomy in an animal model
1Division of Gastroenterology, University of California, Davis Medical Center, Sacramento 95817, USA.
Background:
Endoscopic mucosal resection with a cap-fitted endoscope appears to be as effective but easier to perform than freehand mucosectomy. However, experience with this technique has been limited to small case series and there is a lack of data from direct comparison trials.
Methods:
Nine pigs were randomized to mucosectomy using a cap-fitted endoscope or the freehand technique. Five mucosal resections were performed at five different sites in the gastric body in each pig. Eight to ten milliliters of a saline, epinephrine, and methylene blue solution were injected to raise a bleb to simulate a mucosal lesion. Endoscopic mucosal resection with a cap-fitted endoscope was performed by suctioning the bleb into the cap device pre-looped with an oval snare; mucosectomy was performed electrosurgically. Freehand mucosectomy was performed by encircling and then resecting the bleb using an oval snare. The ease of procedure (1 = "very easy" to 5 = "unable to complete") was assessed after each resection. The animals were recovered, maintained, and then humanely sacrificed after 2 weeks.
Results:
Five pigs underwent endoscopic mucosal resection with a cap-fitted endoscope and 4 underwent freehand mucosectomy. Eight animals survived for 2 weeks without complications and one animal from the freehand group died of massive hemorrhage within 48 hours of endoscopy. Both methods produced rounded resection specimens measuring 9 to 12 mm in diameter of the full thickness of the mucosa and the submucosa. Overall ease of resection was 1.84 +/- 0.52 for the cap-fitted group and 2.98 +/- 0.86 for the freehand group (p < 0.0001). All of the sites identified at autopsy were completely re-epithelialized, except for the five sites found in the pig that died prematurely.
Conclusions:
Endoscopic mucosal resection with a cap-fitted endoscope is as effective, safe, but easier to perform compared with freehand mucosectomy.
Insights
Cap-fitted endoscopic mucosal resection (EMR) is as effective and safe as freehand EMR, but significantly easier to perform. This study in pigs demonstrated the practical advantages of the cap-fitted technique for gastrointestinal procedures.
Area of Science:
- Gastroenterology
- Endoscopic Surgery
- Surgical Techniques
Background:
- Endoscopic mucosal resection (EMR) is a key technique for gastrointestinal lesion removal.
- Cap-fitted EMR is proposed as an easier alternative to freehand EMR.
- Limited comparative data exists for cap-fitted EMR.
Purpose of the Study:
- To directly compare the efficacy and ease of performance between cap-fitted EMR and freehand EMR.
- To evaluate the safety and outcomes of both EMR techniques in a preclinical model.
Main Methods:
- A randomized trial involving nine pigs undergoing five mucosal resections each.
- Comparison between cap-fitted EMR (suction-assisted, electrosurgical resection) and freehand EMR (snare encirclement and resection).
- Assessment of procedural ease on a 1-5 scale, followed by 2-week recovery and autopsy.
Main Results:
- Cap-fitted EMR group (5 pigs) and freehand EMR group (4 pigs) both yielded full-thickness mucosal and submucosal specimens.
- Significantly higher ease of resection scores for cap-fitted EMR (1.84 ± 0.52) versus freehand EMR (2.98 ± 0.86; p < 0.0001).
- One fatality due to hemorrhage in the freehand group; otherwise, all sites showed complete re-epithelialization at 2 weeks.
Conclusions:
- Cap-fitted EMR is as effective and safe as freehand EMR.
- Cap-fitted EMR offers a significantly easier and more practical approach for mucosal resection.
- This technique holds promise for improving endoscopic procedures.