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Endoscopic full-thickness resection of gastric lesions using a novel grasp-and-snare technique: evaluation in a porcine survival model

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Abstract

Background

Endoscopic full-thickness resection (EFTR) is a less-invasive method of en bloc removal of gastrointestinal tumors. In a previous nonsurvival animal experiment, the feasibility of a novel grasp-and-snare EFTR technique using a prototype tissue-lifting device was demonstrated. The objective of this study was to evaluate the safety and outcomes of this EFTR method in a porcine survival model.

Methods

EFTR of model stomach tumors was performed in seven pigs using a double-channel endoscope with a prototype tissue-lifting device through one channel and snare through the other. The lifting device was advanced through the snare loop and anchored to the gastric wall adjacent the model tumor. The lifting device was then partially retracted into the endoscope, causing the target tissue, including tumor, to evert into the gastric lumen. The open snare was then placed beyond the tumor around uninvolved gastric tissue. Resection was performed by delivering an electrosurgical current through the snare. EFTR defects were closed by using tissue anchors. After an intended 10-day observation period, the pigs were euthanized and necropsy was performed.

Results

All seven resections were successful with negative gross margins. No immediate complications occurred. Two defect closures failed during the early postoperative period, leading to infectious complications. The remaining intact closures were complicated by adjacent ulcers, one of which resulted in hemorrhage.

Conclusions

Endoscopic full-thickness resection of gastric lesions using the grasp-and-snare technique is feasible in pigs. In this experiment, complications related to closure were significant. Further evaluation and modification of closure technique is necessary before studying this method of EFTR in humans.

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Acknowledgment

The authors acknowledge Daniel S. Cutler, Medical Illustrator at the Ann Arbor Veterans Affairs Healthcare Center, for producing Fig. 6.

Disclosures

B. Joseph Elmunzer, Akbar K. Waljee, Jason R. Taylor, Gail M. Rising, Joseph A. Trunzo, Grace H. Elta, James M. Scheiman, Jeffrey L. Ponsky, Jeffrey M. Marks, Richard S. Kwon have no conflicts of interest to disclose pertaining to this manuscript. This study was funded by a NOSCAR research grant. The tissue anchor system was provided by Ethicon Endosurgery through an investigator-initiated product grant.

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Authors and Affiliations

  1. Division of Gastroenterology, University of Michigan Medical Center, 3912 Taubman Center, SPC 5362, Ann Arbor, MI, 48109, USA

    B. Joseph Elmunzer, Akbar K. Waljee, Jason R. Taylor, Grace H. Elta, James M. Scheiman & Richard S. Kwon

  2. Unit for Laboratory Animal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA

    Gail M. Rising

  3. Department of Surgery, University Hospitals Case Medical Center, Cleveland, OH, USA

    Joseph A. Trunzo, Jeffrey L. Ponsky & Jeffrey M. Marks

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  1. B. Joseph Elmunzer
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  2. Akbar K. Waljee
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  3. Jason R. Taylor
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  4. Gail M. Rising
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  5. Joseph A. Trunzo
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  6. Grace H. Elta
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  7. James M. Scheiman
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  8. Jeffrey L. Ponsky
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  9. Jeffrey M. Marks
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  10. Richard S. Kwon
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Correspondence to B. Joseph Elmunzer.

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Elmunzer, B.J., Waljee, A.K., Taylor, J.R. et al. Endoscopic full-thickness resection of gastric lesions using a novel grasp-and-snare technique: evaluation in a porcine survival model. Surg Endosc 24, 1573–1580 (2010). https://doi.org/10.1007/s00464-009-0813-8

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  • DOI: https://doi.org/10.1007/s00464-009-0813-8

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