Evaluation of Embryonic NOTES for Gastric Submucosal Tumors in Beagles

Overview

This preclinical study assessed a novel embryonic-natural orifice transluminal endoscopic surgery (E-NOTES) technique for resecting gastric muscularis propria submucosal tumors (MP-SMTs) in beagles. The procedure achieved complete tumor removal with preserved mucosal integrity, minimal bleeding, no major complications, and rapid postoperative recovery.

Background

Gastrointestinal submucosal tumors (SMTs), especially those originating from the muscularis propria (MP) layer, pose challenges for endoscopic resection due to risks of perforation and hemorrhage. Conventional techniques like endoscopic submucosal excavation (ESE) and endoscopic full-thickness resection (EFTR) have limitations including significant complication rates. Embryonic-natural orifice transluminal endoscopic surgery (E-NOTES) offers a minimally invasive, retrograde approach via the umbilicus, enabling precise resection while preserving mucosal integrity and potentially reducing complications.

Data Highlights

Key Findings

• All E-NOTES procedures were successfully completed without conversion to laparoscopy.
• The mean lesion size was approximately 28 mm, with an average operative time of about 64 minutes.
• Minor intraoperative bleeding occurred in over half of the cases but was controllable endoscopically.
• No severe complications such as perforation, peritonitis, or major bleeding were observed.
• Postoperative recovery was rapid, with all animals resuming oral intake within 24 hours.
• Histopathology confirmed complete excision of the muscularis propria lesions with preservation of the mucosal layer.

Clinical Implications

E-NOTES represents a promising minimally invasive technique for resecting gastric MP-SMTs while preserving mucosal integrity, potentially reducing the risk of complications associated with conventional methods. Its ability to maintain mucosal layers may minimize infection and promote faster recovery, suggesting utility in clinical settings pending further translational studies.

Conclusion

The study demonstrates that E-NOTES is a feasible and safe approach for complete resection of gastric MP-SMTs in a canine model, preserving mucosal integrity and enabling rapid postoperative recovery. These encouraging results warrant further refinement and clinical evaluation.

References

1. Evaluation of Embryonic Natural Orifice Transluminal Endoscopic Surgery for Submucosal Tumors with Preservation of Mucosal Integrity in a Beagle Model -- 2023