Eur J Pediatr Surg 2012; 22(03): 217-221
DOI: 10.1055/s-0032-1308711
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Submucosal Endoscopic Myotomies for Esophageal Lengthening: A Novel Minimally Invasive Technique with Feasibility Study

James Wall
1   Department of Pediatric Surgery, Lucile Packard Children's Hospital at Stanford, Stanford, California, United States
2   Department of Digestive Surgery, IRCAD, Strasbourg, France
,
Silvana Perretta
2   Department of Digestive Surgery, IRCAD, Strasbourg, France
,
Michele Diana
2   Department of Digestive Surgery, IRCAD, Strasbourg, France
,
Parag Dhumane
2   Department of Digestive Surgery, IRCAD, Strasbourg, France
,
Jose-Ignatio Alvar Haro
2   Department of Digestive Surgery, IRCAD, Strasbourg, France
,
Bernard Dallemagne
2   Department of Digestive Surgery, IRCAD, Strasbourg, France
,
Francois Becmeur
3   Department of Pediatric Surgery, University Hospital of Strasbourg, Strasbourg, France
,
Thomas Krummel
1   Department of Pediatric Surgery, Lucile Packard Children's Hospital at Stanford, Stanford, California, United States
,
Jacques Marescaux
2   Department of Digestive Surgery, IRCAD, Strasbourg, France
› Author Affiliations
Further Information

Publication History

18 December 2011

21 January 2012

Publication Date:
10 May 2012 (online)

Abstract

Background Replacement conduits carry significant morbidity in long gap esophageal atresia. Surgical myotomies can lengthen the esophagus, but have not gained widespread adoption due to long-term dilatation. The aim of this study is to assess the feasibility of an emerging minimally invasive technique of submucosal endoscopic myotomy for esophageal lengthening.

Methods Bilateral submucosal lengthening endoscopic myotomies (BSLEM) were performed in three swine. Circular esophageal muscle fibers were selectively divided in a bilateral 3 cm longitudinal pattern. Ex-vivo tensile testing was performed on the BSLEM and compared with three circular myotomies, three spiral myotomies, and three controls.

Results BSLEM was completed in all cases with one esophageal microperforation. The mean operating time was 38 minutes. Over physiologic force ranges of 0 to 100 g, the percentage esophageal elongation was significantly different among the four groups (p < 0.05). Spiral myotomy enabled the maximal lengthening among the techniques. BSLEM enabled lengthening significantly greater than controls, but less than both types of surgical myotomy.

Conclusions BSELM is feasible and allows significant esophageal lengthening. Unlike surgical myotomies, BSELM enables selective division of circular fibers to potentially preserve perfusion near the anastomosis and prevent long-term dilatation. Studies are ongoing to characterize the ideal pattern of selective endoscopic myotomy and long-term effects.

 
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