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Circumferential endoscopic mucosal resection in the swine esophagus assisted by a cap attachment
Jan P Kamler1, Richardo Borsatto, Kenneth F Binmoeller
1Division of Gastroenterology, University of California-San Diego, USA.
Background:
The feasibility and safety of piecemeal, circumferential endoscopic mucosal resection of the distal esophagus are unknown. This study assessed this procedure in a porcine model.
Methods:
Different techniques of endoscopic mucosal resection were tested in Phase I of the study in two animals. During Phase II, 6 pigs underwent piecemeal cap-assisted EMR of the distal esophagus. The mucosa of one half of the circumference of the distal 5 cm of the esophagus was resected. After complete endoscopic re-epithelization, endoscopic mucosal resection was performed on the remaining unresected hemi-circumference. Healing was promoted by daily administration of lansoprazole and documented by weekly endoscopy.
Observations:
In Phase I, one perforation occurred during initial testing of cap-assisted endoscopic mucosal resection. Subsequent cap-assisted endoscopic mucosal resection led to homogenous and uniform piecemeal resection of mucosa. In Phase II, circumferential cap-assisted endoscopic mucosal resection was performed in 6 pigs without perforation or major bleeding. Complete endoscopic re-epithelization occurred over a mean of 3.6 weeks (range: 3-5). Strictures developed in 3 animals.
Conclusions:
Piecemeal circumferential cap-assisted endoscopic mucosal resection is safe and feasible in the normal swine esophagus. Proper technique for cap-assisted piecemeal endoscopic mucosal resection is necessary to minimize the risk of perforation. Procedural complications include esophageal stricture formation.