Efficacy and safety of an internal magnet traction device for endoscopic submucosal dissection: ex vivo study in a porcine model (with video).

Background: Appropriate traction allows for safer and easier endoscopic submucosal dissection (ESD). The aim of this study was to evaluate the efficacy and safety of an internal magnet traction device (MTD) for ESD in an ex vivo porcine model.

Methods: The MTD consisted of a small neodymium magnet and a suture attached to a through-the-scope clip.

Endoscopic magnet placement into subadventitial tunnels for augmenting the lower esophageal sphincter using submucosal endoscopy: ex vivo and in vivo study in a porcine model (with video).

Background And Aims: Endolumenal therapies serve as a treatment option for GERD. This study aimed to determine if magnets could be placed endoscopically using the adventitial layer to create a subadventitial space near the esophagogastric junction to augment the lower esophageal sphincter using submucosal endoscopy.

Methods: This study consisted of 2 phases, ex vivo and in vivo, with domestic pig esophagus.

Endoscopic muscle biopsy sampling of the duodenum and rectum: a pilot survival study in a porcine model to detect myenteric neurons.

Background And Aims: Small bowel and colorectal muscle biopsy sampling requires a surgical approach. Advancing our understanding of the pathophysiology of motility disorders, such as functional bowel disorders, intestinal pseudo-obstruction, and slow-transit constipation, is hindered by our inability to noninvasively obtain muscularis propria (MP) for evaluation of multiple cell types, including myenteric neurons. The aims of this study were to determine (1) technical feasibility, reproducibility, and safety of performing duodenal endoscopic muscle biopsy sampling (dEMB) and rectal endoscopic muscle biopsy sampling (rEMB) using a clip-assist technique and (2) the presence of myenteric neurons in tissue samples.

Endoscopic full-thickness resection using suture loop needle T-tag tissue anchors in the porcine stomach (with video).

Background And Aims: Endoscopic full-thickness resection (EFTR) is still challenging, and a reliable technique is desirable. The aim of this study was to evaluate the feasibility of controlled EFTR using a pseudopolyp made from suture loop needle T-tag (SLNT) tissue anchors in ex vivo porcine stomachs.

Methods: Five pig stomachs were used.

Randomized controlled trial comparing submucosal endoscopy with mucosal resection and endoscopic submucosal dissection in the esophagus and stomach: Animal study.

Background And Aim: In Western countries, endoscopic submucosal dissection (ESD) has not prevailed as a result of training problems and a target patient population. We have previously reported a hybrid ESD technique, submucosal endoscopy with mucosal resection (SEMR), in which the submucosal dissection is carried out chiefly by blunt balloon dissection. We have also reported successful application in the porcine colon.

Effects of carbon dioxide insufflation during direct cholangioscopy on biliary pressures and vital parameters: a pilot study in porcine models.

Background And Aims: Direct per-oral cholangioscopy allows endoscopic visualization of the biliary tract. Insufflation with carbon dioxide (CO) is an alternative to saline solution irrigation during direct cholangioscopy. There are no data on maximal CO insufflation in direct cholangioscopy without causing biliary barotrauma or fatal gas embolism.

Innovative gastric endoscopic muscle biopsy to identify all cell types, including myenteric neurons and interstitial cells of Cajal in patients with idiopathic gastroparesis: a feasibility study (with video).

Background And Aims: The pathophysiology of some GI neuromuscular diseases remains largely unknown. This is in part due to the inability to obtain ample deep gastric wall biopsies that include the intermuscular layer of the muscularis propria (MP) to evaluate the enteric nervous system, interstitial cells of Cajal (ICCs), and related cells. We report on a novel technique for gastric endoscopic muscle biopsy (gEMB).

Submucosal endoscopy as an aid to full-thickness resection: pilot study in the porcine stomach.

Background: Endoscopic full-thickness resection (EFTR) is commonly performed with laparoscopic assistance. Submucosal endoscopy with full-thickness resection (SEFTR) is a new technique that combines submucosal endoscopy with the mucosal safety valve flap method to enable EFTR.

Objective: Pilot evaluation of the feasibility and safety of SEFTR in an animal model.

Transcolonic peritoneoscopy by using submucosal endoscopy with mucosal flap for the detection of peritoneal bead targeting in the porcine survival model: a feasibility and effectiveness study.

Background: Staging peritoneoscopy is typically done by laparoscopy in the operating room. Natural orifice transluminal endoscopic surgery peritoneoscopy is an appealing alternative to the current approach. Transcolonic submucosal endoscopy with mucosal flap (SEMF) may provide natural orifice transluminal endoscopic surgery peritoneoscopy.

Submucosal endoscopy with mucosal resection (SEMR): a new hybrid technique of endoscopic submucosal balloon dissection in the porcine rectosigmoid colon.

Background: We developed a technique, submucosal endoscopy with mucosal resection (SEMR) intended to make endoscopic submucosal dissection easier and safer. With this technique, the submucosal layer is balloon dissected in lieu of electrosurgical knife dissection. The aim of this study was to further evaluate SEMR in the porcine rectum and colon.

Endoscopic full-thickness biopsy of the gastric wall with defect closure by using an endoscopic suturing device: survival porcine study.

Background: The pathogenesis of several common gastric motility diseases and functional GI disorders remains essentially unexplained. Gastric wall biopsies that include the muscularis propria to evaluate the enteric nervous system, interstitial cells of Cajal, and immune cells can provide important insights for our understanding of the etiology of these disorders.

Objectives: To determine the technical feasibility, reproducibility, and safety of performing a full-thickness gastric biopsy (FTGB) by using a submucosal endoscopy with mucosal flap (SEMF) technique; the technical feasibility, reproducibility, and safety of tissue closure by using an endoscopic suturing device; the ability to identify myenteric ganglia in resected specimens; and the long-term safety.

Submucosal endoscopy with mucosal resection: a hybrid endoscopic submucosal dissection in the porcine rectum and distal colon.

Background: Endoscopic submucosal dissection (ESD) has appeal for en bloc resection of large flat colorectal polyps but carries appreciable risk and demands a high level of expertise and training. Undermining flat and laterally spreading colorectal polyps by using submucosal endoscopy with the mucosal safety valve flap (SEMF) may be combined with ESD to offer a hybrid technique that is easier and safer.

Objective: To determine the feasibility of combining SEMF and ESD for the removal of progressively larger areas of the mucosa in the porcine rectum and colon.

Chemically assisted endoscopic mechanical submucosal dissection by using mesna.

Background: A class of thiol compounds, mesna (sodium-2-mercaptoethanesulfonate), has been used to facilitate tissue dissection in surgical fields.

Objectives: To evaluate the technical feasibility and efficacy of chemically assisted endoscopic mechanical submucosal dissection (CAEMSD) by using mesna.

Design: An in vivo controlled blind trial by using porcine models.

Pilot study of transesophageal endoscopic epicardial coagulation by submucosal endoscopy with the mucosal flap safety valve technique (with videos).

Background: We previously demonstrated that the thoracic cavity could be safely accessed by submucosal endoscopy with the mucosal flap safety valve (SEMF) technique.

Objectives: To evaluate the technical feasibility of transesophageal access to the heart and epicardial ablation.

Design: One-week survival study with 5 porcine models.

Endoscopic "no hole" full-thickness biopsy of the stomach to detect myenteric ganglia.

Background: The etiology of several common gastric motility diseases remains largely unknown. Gastric wall biopsy specimens that include the muscularis propria to evaluate the enteric nervous system, interstitial cells of Cajal, and related cells are essential to promote our understanding of the pathophysiologic mechanisms. On the basis of our previous work, a double EMR technique provided sufficient tissue to identify myenteric ganglia.

Mucosal atrophy in celiac disease: extent of involvement, correlation with clinical presentation, and response to treatment.

Background & Aims: Wireless capsule endoscopy provides an opportunity to study the macroscopic features in celiac disease by providing a magnified view of the intestinal mucosa. In this study, we evaluated the following: (1) the distribution of atrophy in untreated celiac disease, (2) the correlation between extent of changes and clinical manifestations, (3) the accuracy and interobserver agreement of wireless capsule endoscopy assessment, and (4) the effect of gluten withdrawal.

Methods: Thirty-eight consecutive patients with untreated biopsy-proven celiac disease underwent wireless capsule endoscopy.

Evaluation of endoscopic approaches for deep gastric-muscle-wall biopsies: what works?

Background: A major barrier to furthering our understanding of the pathophysiology of neuromuscular GI diseases, including functional GI disorders, is the inability to obtain deep gastric-wall biopsy specimens that include both layers of the muscularis propria, which allows evaluation of specific cell types, including myenteric ganglia.

Objectives: The aims of this preclinical study were to (1) evaluate different endoscopic approaches for obtaining deep gastric-muscle-wall biopsy specimens and (2) determine if myenteric ganglia were present in the tissue samples.

Design And Interventions: This was a preclinical acute study by using a pig model.

Transgastric cholecystectomy: transgastric accessibility to the gallbladder improved with the SEMF method and a novel multibending therapeutic endoscope.

Background: Transgastric cholecystectomy is thought to technically and anatomically challenge a single entry flexible endoscopic approach.

Objectives: To examine the feasibility of a transgastric-only cholecystectomy, endoscope performance in an upper-abdominal operation, and the usefulness of an offset gastrotomy.

Study Design: Animal survival study.

Transesophageal mediastinoscopy by submucosal endoscopy with mucosal flap safety valve technique.

Background: Indications for NOTES (natural orifice transluminal endoscopic surgery) studied so far are limited to intra-abdominal surgery.

Objectives: To determine the technical feasibility and the safety of transesophageal mediastinocosopy by using the submucosal endoscopy with mucosal flap safety valve (SEMF) technique.

Design: Two-week survival study with 4 porcine models.

Submucosal endoscopy with mucosal flap safety valve.

Background: There is no reliable endoscopic method to selectively resect deeper layers of the gut wall or to access the peritoneal cavity and prevent peritoneal soiling.

Objectives: To determine the technical feasibility and safety of submucosal endoscopy with mucosal flap (SEMF) in accessing the peritoneal cavity through a large full-thickness gastric-muscle-wall resection.

Design: Ex vivo feasibility exploration and survival animal study.

Endoscopic full-thickness closure of large gastric perforations by use of tissue anchors.

Background: A flexible needle-catheter tissue-anchoring device was developed to accomplish full-thickness tissue apposition of the GI wall. The aim of this study was to identify the performance of this device for repair of large iatrogenic gastric perforations in a porcine model.

Objectives: Six pigs.

Pilot study of the porcine uterine horn as an in vivo appendicitis model for development of endoscopic transgastric appendectomy.

Background: Iatrogenic inflammation of the porcine uterine horn may serve as an in vivo appendicitis model for the development of endoscopic transgastric appendectomy.

Objective: Five female pigs.

Study Design: Animal study.

Tissue anchors for transmural gut-wall apposition.

Background: With the development of NOTES (natural orifice transluminal endoscopic surgery) and efforts to advance gastric reduction surgery, alternatives for robust tissue apposition apart from suturing and current mucosal clipping devices may be valuable.

Objectives: We attempted to identify functional tissue anchors that could be deployed endoscopically, with the potential to provide transmural tissue apposition.

Design: Short-term animal-survival study.

Prospective controlled assessment of variable stiffness enteroscopy.

Background: Push enteroscopy is a well-established technique for evaluation of the small intestine. However, looping of the enteroscope within the stomach limits depth of insertion. Stiffening overtubes that minimize gastric looping are tolerated marginally by patients and disliked by endoscopists.