Endoscopic circumferential esophageal mucosectomy in a porcine model: An assessment of technical feasibility, safety, and outcome

Background and study aims: Endoscopic mucosectomy has been performed for early cancers and dysplastic lesions ≤2 cm in diameter. The feasibility and safety of mucosectomy for circumferential lesions of the esophagus is uncertain. The aim of this study was to determine the technical feasibility, as well as the short and long-term complication rates, with circumferential endoscopic mucosectomy of the distal esophagus in the pig. Materials and methods: Circumferential endoscopic mucosectomy of the distal 3 cm of the esophagus was performed in four pigs, using a cap mucosectomy device. The animals were sacrificed after 30, 50, 70, and 90 days to assess mucosal regeneration and stricture formation. Results: The procedure time for circumferential endoscopic mucosectomy was 15-30 min. Circumferential endoscopic mucosectomy was technically feasible and without short-term complications. Videotapes of all resections were reviewed to ensure that complete removal of the mucosa was achieved. All mucosectomy specimens underwent histological evaluation. The specimens included the mucosa alone in three of the pigs. Some of the specimens in the fourth pig included a superficial layer of muscularis propria. This pig failed to thrive. Macroscopic examination of the dissected esophageal specimens from the healthy pigs revealed a well-healed, normal-appearing esophagus, whereas a stenosis of 4 × 10 mm was observed in the distal esophagus of the pig that failed to thrive. Conclusions: Circumferential endoscopic mucosectomy of the porcine distal esophagus is feasible and safe. An adequate submucosal saline cushion is essential to prevent stenosis due to deep injury.