TY - JOUR
T1 - Submucosal endoscopy
T2 - a novel approach to en bloc endoscopic mucosal resection (with videos){A figure is presented}
AU - von Delius, Stefan
AU - Feussner, Hubertus
AU - Henke, Julia
AU - Schneider, Armin
AU - Hollweck, Regina
AU - Rösch, Thomas
AU - Prinz, Christian
AU - Schmid, Roland M.
AU - Frimberger, Eckart
N1 - Funding Information:
This study was supported by KARL STORZ GmbH & Co. KG, Tuttlingen, and Erbe Elektromedizin GmbH, Tübingen, Germany. The authors have no other disclosures to make .
PY - 2007/10
Y1 - 2007/10
N2 - Background: The submucosal layer is of eminent importance for endoscopic mucosal resection (EMR) in the GI tract. Objective: Development of submucosal endoscopy, which allows diagnostic and therapeutic endoscopy of the submucosal space (SS) in the esophagus. Design: Acute experiments in a live porcine model. Interventions: An area in the esophagus was marked with a diathermic probe to define a mucosal piece for resection. After local infiltration, a 1- to 2-cm transverse incision was performed 1 to 2 cm proximal and distal of these margins. We entered the SS with a flexible small-caliber videoendoscope through the proximal incision and dissected the fibrous submucosal connective tissue in a longitudinal direction with a blunt forceps. For EMR, the lifted mucosa was subsequently separated by use of an insulated-tip hook needle-knife. Main Outcome Measurements: En bloc resection of prespecified mucosal areas. Results: A total of 15 mucosal pieces were resected in 4 pigs. The size of the resected pieces varied from 1.6 cm × 0.9 cm to 7.4 cm × 1.7 cm ex vivo. In a fifth pig, 2 circular mucosectomies (lengths 3.0 cm and 1.6 cm) were done. All mucosal pieces could be completely resected en bloc. The endoscopic view in the SS was excellent. There were no procedure-related complications. Limitations: The method has not yet been evaluated in humans. Conclusions: Entering the SS for submucosal endoscopy is a novel, innovative, and practicable method for the dissection of mucosal neoplastic lesions. We demonstrated that mucosal areas of various sizes could be resected en bloc without complications.
AB - Background: The submucosal layer is of eminent importance for endoscopic mucosal resection (EMR) in the GI tract. Objective: Development of submucosal endoscopy, which allows diagnostic and therapeutic endoscopy of the submucosal space (SS) in the esophagus. Design: Acute experiments in a live porcine model. Interventions: An area in the esophagus was marked with a diathermic probe to define a mucosal piece for resection. After local infiltration, a 1- to 2-cm transverse incision was performed 1 to 2 cm proximal and distal of these margins. We entered the SS with a flexible small-caliber videoendoscope through the proximal incision and dissected the fibrous submucosal connective tissue in a longitudinal direction with a blunt forceps. For EMR, the lifted mucosa was subsequently separated by use of an insulated-tip hook needle-knife. Main Outcome Measurements: En bloc resection of prespecified mucosal areas. Results: A total of 15 mucosal pieces were resected in 4 pigs. The size of the resected pieces varied from 1.6 cm × 0.9 cm to 7.4 cm × 1.7 cm ex vivo. In a fifth pig, 2 circular mucosectomies (lengths 3.0 cm and 1.6 cm) were done. All mucosal pieces could be completely resected en bloc. The endoscopic view in the SS was excellent. There were no procedure-related complications. Limitations: The method has not yet been evaluated in humans. Conclusions: Entering the SS for submucosal endoscopy is a novel, innovative, and practicable method for the dissection of mucosal neoplastic lesions. We demonstrated that mucosal areas of various sizes could be resected en bloc without complications.
UR - http://www.scopus.com/inward/record.url?scp=34848826875&partnerID=8YFLogxK
U2 - 10.1016/j.gie.2007.03.1095
DO - 10.1016/j.gie.2007.03.1095
M3 - Article
C2 - 17531237
AN - SCOPUS:34848826875
SN - 0016-5107
VL - 66
SP - 753
EP - 756
JO - Gastrointestinal Endoscopy
JF - Gastrointestinal Endoscopy
IS - 4
ER -