A novel endoscopic prototype device for gastric full-thickness biopsy for the histopathologic diagnosis of GI neuromuscular pathology: in vivo porcine long-term survival study (with videos) - 12/01/13
Reprint requests: Annette Fritscher-Ravens, Experimental Endoscopy Unit, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, D-24105 Kiel, GermanyRiassunto |
Background |
Many GI motility disorders are associated with underlying GI neuromuscular pathology, which requires full-thickness biopsies (FTB) for histopathologic diagnosis. Currently, none of the endoscopy-based attempts to obtain FTB specimens have proven suitable for routine use. This study evaluated a novel endoscopic prototype device (ED) for this purpose.
Objective |
To determine (1) the ability of the ED to obtain suitable FTB specimens, (2) associated complications, (3) feasibility of reliable defect closure, and (4) ability to evaluate intramural neuromuscular components.
Design |
Preclinical proof-of-concept study in 30 pigs.
Setting |
Animal laboratory.
Intervention |
Gastric FTB specimens were obtained with a circular cutter and anchor. The defect was closed by over-the-scope clips/T-tags. The resection site was inspected via laparoscopy. After 2 to 4 weeks, necropsy was carried out to evaluate late complications.
Main Outcome Measurements |
Feasibility, safety, and closure rate of the procedure. FTB specimens were assessed by histology/immunohistochemistry to visualize enteric neuromusculature.
Results |
A total of 29 of 30 procedures were successfully performed; one hemorrhage required endoscopic treatment. A total of 29 of 30 FTB specimens (mean diameter 9.1 mm) were retrieved in 7.1 ± 0.4 minutes (range 3.0-12.5 minutes), displaying optimal tissue quality. Defect closure took 10.8 ± 0.9 minutes (range 7.2-32 minutes). Laparoscopy did not reveal damage to adjacent organs. Necropsy showed well-healed scars at the resection site and no complications, peritonitis, or abscess formation. Histology showed smooth muscle layers and submucosal and myenteric ganglia.
Limitations |
Survival animal pilotstudy, no patients.
Conclusion |
The novel ED enabled safe harvesting of well-preserved FTB specimens. Defect closure proved to be reliable. All neuromuscular structures relevant for histopathologic evaluation of GI neuromuscular pathology were demonstrated. Further studies are needed to verify the efficacy of this prototype device in the entire gut and in humans.
Il testo completo di questo articolo è disponibile in PDF.Abbreviations : ED, FTB, IBS, NOTES, TRIS
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| DISCLOSURE: The study was supported by internal university research funds to the primary investigator. A. Fritscher-Ravens has a holding patents relationship with Cook. No other financial relationships relevant to this publication were disclosed. |
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| If you would like to chat with an author of this article, you may contact Dr Fritscher-Ravens at fri.rav@btopenworld.com. |
Vol 77 - N° 2
P. 262-271 - febbraio 2013 Ritorno al numero
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