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Laparoscopic transgastric circumferential stapler-assisted vs. endoscopic esophageal mucosectomy in a porcine model

Background and study aims: Extensive 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. Methods: SAM was evaluated in two phases. The feasib...

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Main Authors: Steinemann, Daniel (Author) , Müller, Philip C. (Author) , Sauer, Peter (Author) , Schaible, Anja (Author) , Lasitschka, Felix (Author) , Schwarz, Anne-Catherine (Author) , Müller, Beat P. (Author) , Linke, Georg R. (Author)
Format: Article (Journal)
Language:English
Published: 16. März 2017
In: Endoscopy
Year: 2017, Volume: 49, Issue: 07, Pages: 668-674
ISSN:1438-8812
DOI:10.1055/s-0043-103407
Online Access:Verlag, Volltext: http://dx.doi.org/10.1055/s-0043-103407
Verlag, Volltext: http://www.thieme-connect.de/DOI/DOI?10.1055/s-0043-103407
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Author Notes:Daniel C. Steinemann, Andreas Zerz, Philip C. Müller, Peter Sauer, Anja Schaible, Felix Lasitschka, Anne-Catherine Schwarz, Beat P. Müller-Stich, Georg R. Linke
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Summary:Background and study aims: Extensive 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. Methods: SAM 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. Results: In 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. Conclusions: SAM 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.
Item Description:Publikationsdatum: 16. März 2017 (online)
Gesehen am 18.09.2018
Physical Description:Online Resource
ISSN:1438-8812
DOI:10.1055/s-0043-103407

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