Gastroenterology

Gastroenterology

Volume 156, Issue 5, April 2019, Pages 1250-1252.e1
Gastroenterology

Gastroenterology in Motion
Endoscopic Mediastinal Lymph Node Identification and Resection Using Carbon Nanoparticles in a Porcine Model

https://doi.org/10.1053/j.gastro.2018.12.040Get rights and content

Section snippets

Description of Technology

Six hours before the main procedure, we endoscopically injected 4 mL of CNs suspension (3.6 mL normal saline; 0.4 mL CNs) into the submucosal layer of the right side of the proximal esophagus 55 cm from the tip of the pig’s snout (Figure 1A).

In the main procedure, a cap-based single-channel endoscope is introduced into the proximal esophagus 45 cm from the tip of the snout. A hook-knife is then used to create a 1.5-cm superficial incision in the mucosal layer in the right side of the esophagus.

Video Description

Video 1 shows mediastinal LN resection using the porcine model. The endoscope was advanced into the mediastinum through the submucosal tunnel of the esophageal wall. Mediastinoscopy was performed to detect the LNs in the surrounding mediastinum that was black dyed by CNs. An IT knife, Hook knife, and endoscopic snare were used to resect the LNs from the surrounding structures (Figure 1). The tissue specimens were slowly pulled into the cap by suction and removed by withdrawing the endoscope.

Take Home Message

The CNs technique has been described by surgeons as easy to use for the detection of LNs.2, 3 After submucosal injection, CNs suspension rapidly disseminates inside the lymphatic system and is engulfed by the macrophages; in turn, the macrophages gather in the draining LNs and stain it black. The CNs method would have the potential to assist LN detection during an endoscopic transmural procedure. In our study, we have proved that a transesophageal natural orifice transluminal endoscopic surgery

Acknowledgments

The authors express gratitude to Professor David Y. Graham and Dr. Yuk Tong Lee for their encouragement and assistance in revising the manuscript.

First page preview

First page preview
Click to open first page preview

References (3)

  • H. Kuwano et al.

    Guidelines for diagnosis and treatment of carcinoma of the esophagus April 2012 edited by the Japan Esophageal Society

    Esophagus

    (2015)
There are more references available in the full text version of this article.

Cited by (0)

This article has an accompanying continuing medical education activity, also eligible for MOC credit, on page e14. Learning Objective: Upon completion of this CME activity, successful learners will be able to (1) recognize a novel technique for the development of endoscopic treatment, (2) determine easy to detect lymph nodes accurately based on the presence of carbon nanoparticles, and (3) identify how to use a transesophageal endoscopic method for mediastinal lymph node resection.

Conflicts of interest The authors disclose no conflicts.

Funding Supported by Henan Province Innovation Talents of Science and Technology Plan (No:184200510020); and research team fund of the First Affiliated Hospital of Zhengzhou University.

Author names set in bold indicate co-first authors.

Authors share co-first authorship.

View full text