Submucosal endoscopy – a novel approach to en bloc endoscopic mucosal resection

Aims: The submucosal (SM) layer is of eminent importance for endoscopic mucosal resection in the gastrointestinal tract. SM infiltration is the critical step of tumor invasion and subsequent metastasis. Herein we describe the development of submucosal endoscopy (SE), a novel and innovative method, that allows diagnostic and therapeutic endoscopy of the submucosal space (SS) in the esophagus (E). Materials and methods: SE was performed in pigs under general anesthesia. An area in the E was marked with a diathermic probe to define a mucosal piece for resection. After local infiltration with epinephrine (1:100000)…