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

• Verfasst von: Steinemann, Daniel [VerfasserIn]
• Verfasst von: Müller, Philip C. [VerfasserIn]
• Verfasst von: Sauer, Peter [VerfasserIn]
• Verfasst von: Schaible, Anja [VerfasserIn]
• Verfasst von: Lasitschka, Felix [VerfasserIn]
• Verfasst von: Schwarz, Anne-Catherine [VerfasserIn]
• Verfasst von: Müller, Beat P. [VerfasserIn]
• Verfasst von: Linke, Georg R. [VerfasserIn]
• Titel: Laparoscopic transgastric circumferential stapler-assisted vs. endoscopic esophageal mucosectomy in a porcine model
• Verf.angabe: Daniel C. Steinemann, Andreas Zerz, Philip C. Müller, Peter Sauer, Anja Schaible, Felix Lasitschka, Anne-Catherine Schwarz, Beat P. Müller-Stich, Georg R. Linke
• E-Jahr: 2017
• Jahr: 16. März 2017
• Umfang: 7 S.
• Teil: volume:49
• Teil: year:2017
• Teil: number:07
• Teil: pages:668-674
• Teil: extent:7
• Fussnoten: Publikationsdatum: 16. März 2017 (online) ; Gesehen am 18.09.2018
• Titel Quelle: Enthalten in: Endoscopy
• Ort Quelle: Stuttgart [u.a.] : Thieme, 1969
• Jahr Quelle: 2017
• Band/Heft Quelle: 49(2017), 07, Seite 668-674
• ISSN Quelle: 1438-8812
• DOI: doi:10.1055/s-0043-103407
• Datenträger: Online-Ressource
• Sprache: eng
• K10plus-PPN: 1581065426

Abstract

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.