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Published in: Surgical Endoscopy 2/2011

01-02-2011 | New Technology

Initial experience with Barrett’s strip endoscopic mucosal excision: a new Barrett’s excision device

Authors: András Légner, Rudolf J. Stadlhuber, Fumiaki Yano, Kazuto Tsuboi, Sumeet K. Mittal, Richard I. Rothstein, Charles J. Filipi

Published in: Surgical Endoscopy | Issue 2/2011

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Abstract

Background

Barrett’s mucosa resection techniques are time consuming, often difficult to perform, and used with varying success. This report describes the authors’ results with a new device and technique for strip endoscopic mucosal resection (SEMR) using a cold excision blade.

Methods

A retrospective review of ex vivo and in vivo animal and human esophagi experiments was conducted to develop the essential design characteristics of a transoral strip mucosal excision device. Depth, size, shape, and technique of excision were serially evaluated.

Results

The SEMR device allows precise capsule positioning with satisfactory excision size and depth in ex vivo and in vivo experiments. A total of 10 excisions were performed on five normal ex vivo cadaveric human esophagi. The specimens ranged in size from 3 × 2.5 to 2.5 × 2.2 cm. The average specimen thickness was 0.297 mm. For 147 (99.8%) of 150 fields of examination, muscularis mucosa was included. Six additional in vivo experiments demonstrated device safety and feasibility.

Conclusion

Satisfactory excision depth was reproducible. Further animal survival experiments and clinical trials will define the role of the SEMR device for patients with Barrett’s esophagus.
Literature
1.
go back to reference Barrett NR (1957) The lower esophagus lined by columnar epithelium. Surgery 41:881–894PubMed Barrett NR (1957) The lower esophagus lined by columnar epithelium. Surgery 41:881–894PubMed
2.
go back to reference Blot WJ, Devesa SS, Fraumeni JF Jr (1993) Continuing climb in rates of esophageal adenocarcinoma. JAMA 270:1320–1325CrossRefPubMed Blot WJ, Devesa SS, Fraumeni JF Jr (1993) Continuing climb in rates of esophageal adenocarcinoma. JAMA 270:1320–1325CrossRefPubMed
3.
go back to reference Ell C, May A, Pech O, Gossner L, Guenter E, Behrens A, Nachbar L, Huijsmans J, Vieth M, Stolte M (2007) Curative endoscopic resection of early esophageal adenocarcinomas (Barrett’s cancer). Gastrointest Endosc 65:3–10CrossRefPubMed Ell C, May A, Pech O, Gossner L, Guenter E, Behrens A, Nachbar L, Huijsmans J, Vieth M, Stolte M (2007) Curative endoscopic resection of early esophageal adenocarcinomas (Barrett’s cancer). Gastrointest Endosc 65:3–10CrossRefPubMed
4.
go back to reference Radu A, Grosjean P, Fontolliet C, Monnier P (2004) Endoscopic mucosal resection in the esophagus with a new rigid device: an animal study. Endoscopy 36:298–305CrossRefPubMed Radu A, Grosjean P, Fontolliet C, Monnier P (2004) Endoscopic mucosal resection in the esophagus with a new rigid device: an animal study. Endoscopy 36:298–305CrossRefPubMed
5.
go back to reference Pilloud R, Jaquet Y, Monnier P (2005) Extensive circumferential endoscopic mucosal resection with a new rigid esophagoscope: an animal study. J Thorac Cardiovasc Surg 130:1399–1405CrossRefPubMed Pilloud R, Jaquet Y, Monnier P (2005) Extensive circumferential endoscopic mucosal resection with a new rigid esophagoscope: an animal study. J Thorac Cardiovasc Surg 130:1399–1405CrossRefPubMed
6.
go back to reference Witteman BPL, Foxwell TJ, Monsheimer S, Gerlud A, Eid GM, Nieponice A, O’Rourke RW, Hoppo T, Bouvy ND, Badylak SF, Jobe BA (2009) Transoral endoscopic inner layer esophagectomy: management of high-grade dysplasia and superficial cancer with organ preservation. J Gastrointest Surg 13:2104–2112CrossRefPubMed Witteman BPL, Foxwell TJ, Monsheimer S, Gerlud A, Eid GM, Nieponice A, O’Rourke RW, Hoppo T, Bouvy ND, Badylak SF, Jobe BA (2009) Transoral endoscopic inner layer esophagectomy: management of high-grade dysplasia and superficial cancer with organ preservation. J Gastrointest Surg 13:2104–2112CrossRefPubMed
7.
go back to reference Kamler JP, Borsatto R, Binmoeller KF (2002) Circumferential endoscopic mucosal resection in the swine esophagus assisted by a cap attachment. Gastrointest Endosc Jun 55:923–928CrossRef Kamler JP, Borsatto R, Binmoeller KF (2002) Circumferential endoscopic mucosal resection in the swine esophagus assisted by a cap attachment. Gastrointest Endosc Jun 55:923–928CrossRef
8.
go back to reference von Rahden BH, Feith M, Stein HJ (2006) Limited surgical resection versus local endoscopic therapy of early cancers of the esophagogastric junction. Zentralbl Chir 131:97–104CrossRef von Rahden BH, Feith M, Stein HJ (2006) Limited surgical resection versus local endoscopic therapy of early cancers of the esophagogastric junction. Zentralbl Chir 131:97–104CrossRef
9.
go back to reference Stein HJ, Feith M, von Rahden BH, Siewert JR (2003) Approach to early Barrett’s cancer. World J Surg 27:1040–1046CrossRefPubMed Stein HJ, Feith M, von Rahden BH, Siewert JR (2003) Approach to early Barrett’s cancer. World J Surg 27:1040–1046CrossRefPubMed
10.
go back to reference Nigro JJ, Hagen JA, DeMeester TR, DeMeester SR, Theisen J, Peters JH, Kiyabu M (1999) Occult esophageal adenocarcinoma: extent of disease and implications for effective therapy. Ann Surg 230:433–438CrossRefPubMed Nigro JJ, Hagen JA, DeMeester TR, DeMeester SR, Theisen J, Peters JH, Kiyabu M (1999) Occult esophageal adenocarcinoma: extent of disease and implications for effective therapy. Ann Surg 230:433–438CrossRefPubMed
Metadata
Title
Initial experience with Barrett’s strip endoscopic mucosal excision: a new Barrett’s excision device
Authors
András Légner
Rudolf J. Stadlhuber
Fumiaki Yano
Kazuto Tsuboi
Sumeet K. Mittal
Richard I. Rothstein
Charles J. Filipi
Publication date
01-02-2011
Publisher
Springer-Verlag
Published in
Surgical Endoscopy / Issue 2/2011
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-010-1192-x

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