Water Jet Ablation of Barrett's Esophagus

描述（由申请人提供）： 在过去的40年里，远端食管腺癌的发病率在美国急剧上升。这些病例中的大多数被认为是由一种潜在的优势条件引起的;巴雷特食管（BE）。已经在人类和动物模型中探索了用于消融食管粘膜的各种内窥镜技术。到目前为止，这些技术中没有一种是完全令人满意的。 并发症，如狭窄，穿孔，不完全消融，或需要特殊的内窥镜手术技巧困扰着这些技术。 众所周知，喷水手术刀可选择性切除各种组织，同时保留底层血管。不幸的是，这些装置是刚性的，具有相对较大的横截面，与内窥镜手术不兼容。我们提出了一种基于内窥镜部署的高压液体喷射技术的方法，该技术优先选择柱状食管粘膜。先前进行的离体实验已经证明，液体喷射导管可以消除动物胆囊和小肠中的粘膜衬里，而不会对下面的富含胶原蛋白的粘膜下层造成显著损伤。预计本调查也会出现类似结果。 拟议的研究概述了高压液体喷射导管在BE人体食管切除组织上的设计、开发和试验。在研究的第二部分中，将尝试在类似于人类食管（猪模型）的解剖环境中使用水射流进行内镜粘膜消融。

DESCRIPTION (provided by applicant): The incidence of adinocarcinoma of the distal esophagus has risen dramatically in the U.S. in the past 40 years. Most of these cases are thought to have arisen from a potentially premalignent condition; Barrett's Esophagus (BE). Various endoscopic techniques for ablating the esophageal mucosa have been explored in both humans and animal models. So far none of these techniques has emerged as fully satisfactory. Complications such as stricture, perforation, incomplete ablation, or the requirement for exceptional endoscopic surgical skills have plagued these techniques. Water-jet surgical scalpels are well known for their selective resection of various tissues while conserving underlying vasculature. Unfortunately, these devices are rigid with relatively large cross sections that are not compatible with endoscopic procedures. We propose an approach based on endoscopically deployed high pressure liquid-jet technology that is preferentially selective for columnar esophageal mucosa. Previously conducted ex-vivo experiments have demonstrated that liquid-jet cathers can eliminate mucousal linings in animal gall bladder and small intestine without significant injury to the underlying collagen rich submucosal layer. Similar results are anticipated in this investigation. The proposed research outlines the design, development, and testing of a high-pressure, liquid-jet catheter on human esophagestomy tissue with BE. In a second portion of the study; endoscopic mucosal ablation using the water-jet in an anatomical environment similar to the human esophagus (swine model) will be attempted.