Longterm retention of endoscopically placed hyd

Authors: D W Easter M Yurek G Johnson

Publish Date: 2004/02/02

Volume: 18, Issue: 3, Pages: 448-451

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Abstract

Background Using flexible endoscopic methods hydrogel prostheses can be safely placed retained for long periods of time and removed from the esophageal submucosa of pigs This new technique may have future applications in the treatment of gastroesophageal reflux disease in selected situations Methods In a controlled prospective trial farm pigs n = 28 or Sinclair miniswine n = 18 underwent sequential placements of 2–13 pliable radioopaque hydrogel prostheses into the submucosa of the esophagus during a single endoscopy session A novel endoscopeovertube device was used Followup endoscopy and/or fluoroscopy sessions were videorecorded at 6week 12week 6month and yearly intervals The endoscopic removal of hydrogels was tested in vivo Necropsy specimens were inspected for signs of chronic inflammation Results Overall 98 of delivery attempts were successful 288/293 Only three hydrogels were lost after 6 weeks Shortterm animals n = 36 retained 88 of hydrogels for periods up to 6 months Intact hydrogels n = 12 were easily removed from four animals at endoscopy Longterm subjects had two or three hydrogels per animal using either a beveledneedle device six pigs or a trocar design four pigs Trocar design nine of nine prostheses retained at 3 years 100 Needle design nine of 10 prostheses retained at 3 years 90 No significant adverse event occurred Growth curves were similar between groups All hydrogels remained pliable to gross inspection upon in vivo removal or necropsy Pathology showed minimal fibrosis and no chronic inflammation Conclusions A novel endoscopic overtube device allows for the successful delivery of multiple hydrogel prostheses with acceptable safety and long term retention rates These hydrogel prostheses can also be easily removed from the submucosal space of the esophagus

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