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.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Barrett NR (1957) The lower esophagus lined by columnar epithelium. Surgery 41:881–894
Blot WJ, Devesa SS, Fraumeni JF Jr (1993) Continuing climb in rates of esophageal adenocarcinoma. JAMA 270:1320–1325
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 65:3–10
Radu A, Grosjean P, Fontolliet C, Monnier P (2004) Endoscopic mucosal resection in the esophagus with a new rigid device: an animal study. Endoscopy 36:298–305
Pilloud R, Jaquet Y, Monnier P (2005) Extensive circumferential endoscopic mucosal resection with a new rigid esophagoscope: an animal study. J Thorac Cardiovasc Surg 130:1399–1405
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 13:2104–2112
Kamler JP, Borsatto R, Binmoeller KF (2002) Circumferential endoscopic mucosal resection in the swine esophagus assisted by a cap attachment. Gastrointest Endosc Jun 55:923–928
von Rahden BH, Feith M, Stein HJ (2006) Limited surgical resection versus local endoscopic therapy of early cancers of the esophagogastric junction. Zentralbl Chir 131:97–104
Stein HJ, Feith M, von Rahden BH, Siewert JR (2003) Approach to early Barrett’s cancer. World J Surg 27:1040–1046
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 230:433–438
Acknowledgment
Financial support was provided by SafeStitch Medical Inc., 4400 Biscayne Boulevard, Suite 670, Miami, FL 33137, USA.
Disclosures
Dr. Charles Filipi has an equity interest in SafeStitch Medical Inc. Rudolf J Stadlhuber, Fumiaki Yano, András Légner, Kazuto Tsuboi, and Sumeet K. Mittal have no conflicts of interest or financial ties to disclose. Dr. Richard I Rothstein has acted as a consultant for SafeStitch Medical Inc.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Légner, A., Stadlhuber, R.J., Yano, F. et al. Initial experience with Barrett’s strip endoscopic mucosal excision: a new Barrett’s excision device. Surg Endosc 25, 651–654 (2011). https://doi.org/10.1007/s00464-010-1192-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-010-1192-x