TITLE

Transoral endoscopic inner layer esophagectomy: management of high-grade dysplasia and superficial cancer with organ preservation

AUTHOR(S)
Witteman, Bart P. L.; Foxwell, Tyler J.; Monsheimer, Sandy; Gelrud, Andres; Eid, George M.; Nieponice, Alejandro; O'Rourke, Robert W.; Hoppo, Toshitaka; Bouvy, Nicole D.; Badylak, Stephen F.; Jobe, Blair A.
PUB. DATE
December 2009
SOURCE
Journal of Gastrointestinal Surgery;Dec2009, Vol. 13 Issue 12, p2104
SOURCE TYPE
Academic Journal
DOC. TYPE
journal article
ABSTRACT
Introduction: Limitations of endoscopic therapies for Barrett's esophagus and superficial cancer include a compromised histological assessment, the need for surveillance, subsequent procedures, and stricture formation. Circumferential en bloc resection of the mucosa-submucosa complex followed by deployment of a biologic scaffold onto the remaining muscularis propria may address these concerns. The objective of this study was to determine technical feasibility of transoral resection of the esophageal lining.Materials and Methods: Transoral endoscopic inner layer esophagectomy was performed in ten swine. Endpoints included procedure duration, hemorrhage, number of perforations, and adequacy of resection length and depth.Results: Procedures were successfully completed in all animals without perioperative mortality. Procedure times averaged 179 min (range 125-320). No perforations were found, and a mean of 1.7 (0-4) interventions for hemorrhage was required. Complete longitudinal resection was achieved in nine of ten animals. Resection depth included all mucosal layers in 100% of tissue sections, the submucosal layers, SM1 in 100%, and SM2 in 96%. A portion of SM3 was adherent to the muscularis propria in 70%.Conclusion: Transoral endoscopic resection of the inner esophageal layers was feasible and reproducible. This technique may facilitate a single-step definitive treatment and staging tool for early neoplastic lesions, obviating the need for esophagectomy.
ACCESSION #
45661749

 

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