VideoGIE
Sleeve endoscopic esophageal mucosotomy
Figure 1. Biological matrix was manually attached in a piecewise fashion to a fully covered stent to allow for expansion.
Complete circumferential endoscopic submucosal dissection (ESD) techniques have been used recently to remove specimens en bloc. Although evaluation of margins remains a benefit, scar formation and strictures remain major problems. Stenting with or without biologic matrix may be helpful in preventing strictures, but deployment remains problematic. We present a modified technique of circumferential ESD with a novel over-the-scope stent technique to place a biologic matrix into the mucosal defect. A 12-cm segment of circumferential Barrett’s esophagus with multifocal intramucosal cancer was resected endoscopically by using a modified ESD technique. A novel, over-the-scope technique of deploying a metal stent fully covered with a biologic scaffold is shown (Fig. 1; Video 1, available online at www.giejournal.org). The patient was treated with systemic steroids for 2 weeks. The stent was removed after 5 weeks, and EGD showed partial growth of the matrix on the esophageal muscular wall with no stricture. At 3 months, mild stricturing was treated
This video can be viewed directly from the GIE website or by using the QR code and your mobile device. Download a free QR code scanner by searching “QR Scanner” in your mobile device’s app store.
with balloon dilation. At 6 months, EGD showed a smooth mucosal lining with healing ulceration. Biopsies showed no Barrett’s esophagus. Sleeve endoscopic esophageal mucosotomy is feasible for extended esophageal mucosectomy but with a high stricture rate. Our over-the-scope technique of deploying the biologic matrix with a stent represents a potential solution. DISCLOSURE All authors disclosed no financial relationships relevant to this publication. Ahmed M. Sharata, MD, Christy M. Dunst, MD, Foundation for Surgical Innovation and Education; Gastrointestinal and Minimally Invasive Surgery Division, The Oregon Clinic, Radu Pescarus, MD, Eran Shlomovitz, MD, Ashwin Kurian, MD, Department of Surgery, Providence Portland Medical Center, Kevin M. Reavis, MD, Lee L. Swanström, MD, Foundation for Surgical Innovation and Education; Gastrointestinal and Minimally Invasive Surgery Division, The Oregon Clinic, Portland, Oregon, USA Presented at Digestive Disease Week, May 3-6, 2010, Chicago, Illinois, USA. http://dx.doi.org/10.1016/j.gie.2014.09.045
“Unchaining” a stuck early gastric cancer by endoscopic submucosal dissection EMR removes GI lesions by use of a snare. However, EMR presents a decreasing en bloc resection rate for lesions larger than 2 cm, of irregular shape, or with underlywww.giejournal.org
ing fibrosis. Endoscopic submucosal dissection (ESD) is performed with a dissection knife by a freehand technique. It has demonstrated a significantly increased en bloc Volume 81, No. 5 : 2015 GASTROINTESTINAL ENDOSCOPY 1253
Sleeve endoscopic esophageal mucosotomy
Figure 1. Biological matrix was manually attached in a piecewise fashion to a fully covered stent to allow for expansion.
Complete circumferential endoscopic submucosal dissection (ESD) techniques have been used recently to remove specimens en bloc. Although evaluation of margins remains a benefit, scar formation and strictures remain major problems. Stenting with or without biologic matrix may be helpful in preventing strictures, but deployment remains problematic. We present a modified technique of circumferential ESD with a novel over-the-scope stent technique to place a biologic matrix into the mucosal defect. A 12-cm segment of circumferential Barrett’s esophagus with multifocal intramucosal cancer was resected endoscopically by using a modified ESD technique. A novel, over-the-scope technique of deploying a metal stent fully covered with a biologic scaffold is shown (Fig. 1; Video 1, available online at www.giejournal.org). The patient was treated with systemic steroids for 2 weeks. The stent was removed after 5 weeks, and EGD showed partial growth of the matrix on the esophageal muscular wall with no stricture. At 3 months, mild stricturing was treated
This video can be viewed directly from the GIE website or by using the QR code and your mobile device. Download a free QR code scanner by searching “QR Scanner” in your mobile device’s app store.
with balloon dilation. At 6 months, EGD showed a smooth mucosal lining with healing ulceration. Biopsies showed no Barrett’s esophagus. Sleeve endoscopic esophageal mucosotomy is feasible for extended esophageal mucosectomy but with a high stricture rate. Our over-the-scope technique of deploying the biologic matrix with a stent represents a potential solution. DISCLOSURE All authors disclosed no financial relationships relevant to this publication. Ahmed M. Sharata, MD, Christy M. Dunst, MD, Foundation for Surgical Innovation and Education; Gastrointestinal and Minimally Invasive Surgery Division, The Oregon Clinic, Radu Pescarus, MD, Eran Shlomovitz, MD, Ashwin Kurian, MD, Department of Surgery, Providence Portland Medical Center, Kevin M. Reavis, MD, Lee L. Swanström, MD, Foundation for Surgical Innovation and Education; Gastrointestinal and Minimally Invasive Surgery Division, The Oregon Clinic, Portland, Oregon, USA Presented at Digestive Disease Week, May 3-6, 2010, Chicago, Illinois, USA. http://dx.doi.org/10.1016/j.gie.2014.09.045
“Unchaining” a stuck early gastric cancer by endoscopic submucosal dissection EMR removes GI lesions by use of a snare. However, EMR presents a decreasing en bloc resection rate for lesions larger than 2 cm, of irregular shape, or with underlywww.giejournal.org
ing fibrosis. Endoscopic submucosal dissection (ESD) is performed with a dissection knife by a freehand technique. It has demonstrated a significantly increased en bloc Volume 81, No. 5 : 2015 GASTROINTESTINAL ENDOSCOPY 1253
