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J Thorac Cardiovasc Surg 2005;130:1399
© 2005 The American Association for Thoracic Surgery

General Thoracic Surgery

Extensive circumferential endoscopic mucosal resection with a new rigid esophagoscope: An animal study

Raphaelle Pilloud, MD * , Yves Jaquet, MD, Philippe Monnier, MD

Department of Otolaryngology, Head and Neck Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.

Preliminary results were presented at the annual meeting of the Swiss Society of Otolaryngology, Head and Neck Surgery, Lausanne, Switzerland, June 19-21, 2003.

Received for publication March 30, 2005; revisions received June 1, 2005; accepted for publication June 7, 2005.

* Address for reprints: Raphaelle Pilloud, MD, Department of Otolaryngology, Head and Neck Surgery, Centre Hospitalier Universitaire Vaudois, CH-1011 Lausanne, Switzerland. (Email: raphaelle.pilloud{at}hcuge.ch).

OBJECTIVE: Current endoscopic mucosal resection techniques are suboptimal for large circumferential mucosal resections intended to treat Barrett mucosa with multicentric foci of high-grade intraepithelial neoplasia or early adenocarcinomas. A rigid modified endoscope was developed for extended endoscopic mucosal resection in the esophagus. This pilot animal study investigated the feasibility of circumferential endoscopic mucosal resections of different lengths in the sheep esophagus.

METHODS: Circumferential esophageal endoscopic mucosal resections of 2.2 cm (n = 6), 3.3 cm (n = 6), 4.4 cm (n = 7), and 5.5 cm (n = 5) were performed in 24 sheep. Circumferential resections consisted of two opposite hemicircumferential mucosectomies. Animals were followed up with endoscopic examinations at 1 week and then monthly to 6 months, or until complete re-epithelialization without stenosis eventually ensued. Strictures were treated with a single or repeated dilatations with Savary bougies.

RESULTS: Circumferential resections 2.2 to 5.5 cm in length were successfully performed in 23 of 24 of the animals. One perforation occurred directly after mucosectomy. Accurate depth of resection through the submucosa was obtained in 85% of the specimens. Cicatricial stenosis was controlled in 95% by bougienage.

CONCLUSION: Endoscopic mucosal resection performed with the rigid esophagoscope allowed extensive circumferential resections in a single session. There is thus potential to eradicate complete Barrett esophagus with high-grade intraepithelial neoplasia or early adenocarcinomas.

Abbreviations and Acronyms BE = Barrett esophagus; EMR = endoscopic mucosal resection; HGIN = high-grade intraepithelial neoplasia






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