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

Abstract

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.

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

“…The authors recommended topical application of mitomycin C to prevent the development of stenosis. Subsequently, Pilloud et al [5] from the same group used a second-generation device with a rigid esophagoscope to perform circumferential mucosal resections. Two hemicircumferentially opposite excisions were performed in sheep to obtain a 3608 excision.…”

Diagnosis of Barrett’s Esophagus and Esophageal Neoplasia: East Meets West

“…This approach to BE with high grade dysplasia or early adenocarcinoma may be potentially as effective but safer than esophagectomy 49 . In the future, techniques for complete widespread EMR for treatment of BE 50,51 will become feasible for BE of any length.…”

Stricture prevention after extended circumferential endoscopic mucosal resection by injecting autologous keratinocytes in the sheep esophagus

“…Until the past decade, the only curative surgical option was esophagectomy (fraught with perioperative mortality and morbidity) or brachytherapy with cumbersome multiple treatments. With the development of endoscopic mucosal resection (EMR), a new therapeutic alternative became available [2][3][4][5]. The procedure is minimally invasive and can be offered to patients who are not eligible for esophagectomy as a curative treatment.…”

“…However, for more extensive lesions, postoperative stenosis is a major concern that occurs more frequently when the mucosal defect is larger than 30 mm in length or with a circumferential extension of more than 60 % [4,5,7]. The risk of stenosis can be as high as 62 %, depending on the extent of the circumferential resection [2]. The resulting dysphagia is unacceptable for initially asymptomatic patients.…”

“…The resulting dysphagia is unacceptable for initially asymptomatic patients. Treatment of these strictures consists of repeat bougienage or balloon dilatation with suboptimal improvement of symptoms and potential risks of tears and perforation [2,8]. With multicentric foci of early squamous cell carcinomas or early adenocarcinomas arising in dysplastic Barrett's esophagus, the curative treatment requires complete removal of the cancerous and dysplastic mucosae.…”