Endoscopic mucosal resection using a grasp-and-snare technique

D. von Renteln; A. Schmidt; M. C. Vassiliou; H.-U. Rudolph; K. Caca

doi:10.1055/s-0029-1244121

Endoscopy, Table of Contents

Endoscopy 2010; 42(6): 475-480
DOI: 10.1055/s-0029-1244121

Original article

Endoscopic mucosal resection using a grasp-and-snare technique

D. von Renteln¹ , A. Schmidt¹ , M. C. Vassiliou² , H.-U. Rudolph³ , K. Caca¹

¹Department of Gastroenterology, Hepatology, and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany
²Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
³University Hospital Mannheim, University of Heidelberg, Germany

Abstract

Background and study aim: Endoscopic mucosal resection (EMR) is a minimally invasive method for en bloc removal of superficial gastrointestinal lesions. The aim of this study was to evaluate the feasibility of a novel grasp-and-snare EMR technique.

Methods: In 10 domestic pigs, gastric lesions of approximately 3 cm were marked using electrocautery. EMR was performed using a double-channel endoscope. A novel tissue anchor was used through one channel, and a monofilament snare through the other. After submucosal injection, a circumferential mucosal incision was created. The tissue-anchoring device was then advanced through the open snare and anchored into the submucosal layer. The tissue-anchoring device was partly retracted into the endoscope and the snare was positioned into the circular incision. The snare was subsequently closed and the specimen resected by applying high-frequency electrocautery.

Results: Mean time to perform EMR was 32.4 minutes (range 22 – 41 minutes, SD 6.3). EMR yielded specimens that ranged in area from 2.7 cm (minor axis) by 2.8 cm (major axis) to 4.0 cm by 4.2 cm (mean area 9.36 cm²; range 5.94 – 13.19 cm²; SD ± 2.50). Complete en bloc resection including all electrocautery markings was achieved in 9/10 cases. In one case, resection was achieved in two steps. One gastric wall perforation occurred. No other adverse events were observed.

Conclusions: Grasp-and-snare EMR is feasible in an animal model. The technique can be performed efficiently compared with standard methods. To avoid perforation, caution is needed to ensure that tissue anchor needles are placed within and not deeper than the submucosal layer prior to tissue retraction.

Full Text

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D. von RentelnMD

Department of Gastroenterology, Hepatology and Oncology
Klinikum Ludwigsburg

71640 Ludwigsburg
Germany

Fax: +49-7141-9967219

Email: renteln@gmx.net