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Journal of Gastrointestinal Surgery

, Volume 13, Issue 12, pp 2104–2112 | Cite as

Transoral Endoscopic Inner Layer Esophagectomy: Management of High-Grade Dysplasia and Superficial Cancer with Organ Preservation

  • Bart P. L. Witteman
  • Tyler J. Foxwell
  • Sandy Monsheimer
  • Andres Gelrud
  • George M. Eid
  • Alejandro Nieponice
  • Robert W. O’Rourke
  • Toshitaka Hoppo
  • Nicole D. Bouvy
  • Stephen F. Badylak
  • Blair A. JobeEmail author
2009 SSAT Plenary Presentation

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.

Keywords

Endoscopy Esophagus Barrett’s esophagus High-grade dysplasia Esophagectomy Cancer Transoral Incisionless 

Abbreviations

TEE

Transoral endoscopic inner layer esophagectomy

MSC

Mucosa–submucosa complex

Notes

Conflict of Interest

The authors report that there are no disclosures relevant to this publication.

Funding

This study was supported by the Robert Anthony McHugh Research Fund for the Prevention and Early Detection of Esophageal Cancer, an American Surgical Association Foundation Fellowship Award (RWO), and National Institutes of Health grants K23 DK066165-01 (BAJ) and K08 DK074397 (RWO).

Supplementary material

ESM Video 1

(WMV 14.3 MB)

ESM Video 2

(WMV 11.5 MB)

ESM Video 3

(WMV 356 MB)

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Copyright information

© The Society for Surgery of the Alimentary Tract 2009

Authors and Affiliations

  • Bart P. L. Witteman
    • 1
  • Tyler J. Foxwell
    • 1
  • Sandy Monsheimer
    • 1
  • Andres Gelrud
    • 2
  • George M. Eid
    • 3
  • Alejandro Nieponice
    • 3
    • 4
  • Robert W. O’Rourke
    • 5
  • Toshitaka Hoppo
    • 1
  • Nicole D. Bouvy
    • 6
  • Stephen F. Badylak
    • 3
    • 4
  • Blair A. Jobe
    • 1
    • 7
    Email author
  1. 1.Division of Thoracic and Foregut Surgery, Heart, Lung and Esophageal Surgery InstituteUniversity of PittsburghPittsburghUSA
  2. 2.Department of Medicine, Division of GastroenterologyUniversity of PittsburghPittsburghUSA
  3. 3.Department of SurgeryUniversity of PittsburghPittsburghUSA
  4. 4.McGowan Institute for Regenerative MedicineUniversity of PittsburghPittsburghUSA
  5. 5.Department of SurgeryOregon Health & Science UniversityPortlandUSA
  6. 6.Department of SurgeryMaastricht University Medical CentreMaastrichtThe Netherlands
  7. 7.Shadyside Medical CenterPittsburghUSA

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