Eran Shlomovitz

Sleeve endoscopic esophageal mucosotomy

Complete circumferential endoscopic submucosal dissection (ESD) techniques have been used recently to remove specimens en bloc. Although evaluation ofmargins remains a benefit, scar formation and strictures remain major problems. Stenting with or without biologic matrix may be helpful in preventing strictures, but deployment remains problematic. We present a modified technique of circumferential ESD with a novel over-the-scope stent technique to place a biologic matrix into the mucosal defect. A 12-cm segment of circumferential Barrett’s esophagus with multifocal intramucosal cancer was resected endoscopically by using a modified ESD technique. A novel, over-the-scope technique of deploying a metal stent fully covered with a biologic scaffold is shown (Fig. 1; Video 1, available online at www.giejournal.org). The patient was treated with systemic steroids for 2 weeks. The stent was removed after 5 weeks, and EGD showed partial growth of the matrix on the esophageal muscular wall with no stricture. At 3 months, mild stricturing was treated