Chemically assisted endoscopic mechanical submucosal dissection by using mesna |
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Authors: | Sumiyama Kazuki Gostout Christopher J Rajan Elizabeth Bakken Timothy A Knipschield Mary A |
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Institution: | Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA. |
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Abstract: | 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. SETTINGS: Nonsurvival study in an animal laboratory. INTERVENTIONS: Six pigs were studied. Mucosal targets of about 2 cm (estimated) for treatment were created with a circle of cauterized spots along the greater curvature of the gastric body and the antrum. A mesna solution or the control hydroxypropyl methylcellulose solution was submucosally injected. The target mucosa was mechanically isolated with balloon dissection and removed by circumferential incision with a hook-knife inserted into the submucosal space. Necropsy and mucosal specimens from both groups were examined by histology. RESULTS: En bloc resection of the target was achieved in all 8 attempts of the mesna group and in 7 of 8 attempts of the control group. Use of mesna significantly reduced tissue resistance to the initial balloon-catheter insertion into the submucosa and the technical difficulty of subsequent submucosal balloon dissection by using a subjective grading system (P < .05). There was no difference in histology between both groups. CONCLUSIONS: CAEMSD is a unique methodology to facilitate mucosal resection. |
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Keywords: | CAEMSD chemically assisted endoscopic mechanical submucosal dissection ESD endoscopic submucosal dissection HPMC hydroxypropyl methylcellulose SEMF submucosal endoscopy with mucosal flap SEMR submucosal endoscopy with mucosal resection |
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