Extensive circumferential endoscopic mucosal resection with a new rigid esophagoscope: An animal study Raphaelle Pilloud, MD, Yves Jaquet, MD, Philippe.

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Presentation transcript:

Extensive circumferential endoscopic mucosal resection with a new rigid esophagoscope: An animal study Raphaelle Pilloud, MD, Yves Jaquet, MD, Philippe Monnier, MD The Journal of Thoracic and Cardiovascular Surgery Volume 130, Issue 5, Pages 1399.e1-1399.e9 (November 2005) DOI: 10.1016/j.jtcvs.2005.06.038 Copyright © 2005 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 New rigid esophagoscope for mucosectomy. a, Large view. b, Outer tube is introduced in esophagus. Inner tube seals distal aperture. c, Cartridge and its transparent window (5.5 cm in length) are placed inside outer tube. Resection wire loop moves from distal edge of window toward proximal edge. The Journal of Thoracic and Cardiovascular Surgery 2005 130, 1399.e1-1399.e9DOI: (10.1016/j.jtcvs.2005.06.038) Copyright © 2005 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Resected specimen and corresponding esophageal segment (Van Gieson staining). Transverse section with resected specimen facing its corresponding esophageal wall. Cut was performed at regular depth through submucosa. The Journal of Thoracic and Cardiovascular Surgery 2005 130, 1399.e1-1399.e9DOI: (10.1016/j.jtcvs.2005.06.038) Copyright © 2005 The American Association for Thoracic Surgery Terms and Conditions

Figure E1 Principle. Negative pressure is applied inside resectoscope, and mucosa is sucked against perforated transparent window. Deep section (dashed lines) is performed at regular depth throughout submucosa. Lesion to be removed is located through 30° angulated telescope, which also allows control of aspiration. LMM, Lamina muscularis mucosae; MPI, muscularis propria interna; MPE, muscularis propria externa. The Journal of Thoracic and Cardiovascular Surgery 2005 130, 1399.e1-1399.e9DOI: (10.1016/j.jtcvs.2005.06.038) Copyright © 2005 The American Association for Thoracic Surgery Terms and Conditions

Figure E2 Endoscopic view. a, Endoscopic view after resection: mucosa was removed circumferentially over 5.5 cm in length. b, Endoscopic view showing complete re-epithelialization (4-month follow-up): cicatricial mucosa and absence of stenosis. This animal underwent three dilatation procedures. The Journal of Thoracic and Cardiovascular Surgery 2005 130, 1399.e1-1399.e9DOI: (10.1016/j.jtcvs.2005.06.038) Copyright © 2005 The American Association for Thoracic Surgery Terms and Conditions

Figure E3 Healed esophagus. Longitudinal section of healed esophagus after 4.4-cm long EMR (Masson trichrome staining) showing distal section margin with interruption of lamina muscularis mucosae (a) and area of transmural fibrosis (b). The Journal of Thoracic and Cardiovascular Surgery 2005 130, 1399.e1-1399.e9DOI: (10.1016/j.jtcvs.2005.06.038) Copyright © 2005 The American Association for Thoracic Surgery Terms and Conditions