Demonstration of feasibility and technique of transesophageal endoscopic epicardial access in a porcine model.

BACKGROUND AND AIMS: Peroral endoscopic myotomy uses a submucosal tunnel that staggers the esophageal mucosotomy and myotomy, allowing minimally invasive interventions in the esophagus to treat achalasia. Our goal was to assess the feasibility of this method to access the mediastinum to perform endoscopic epicardial access and pericardial window in a porcine model.

METHODS

Experiments were conducted to assess the feasibility of this procedure. Commonly available ERCP and EUS instruments were used to show epicardial access under both direct transesophageal mediastinoscopic visualization and EUS guidance.

RESULTS

In experiments, we successfully placed catheters in the pericardial space without hemodynamic instability or adverse events. A pericardial window was performed in other experiments, draining the instilled simulated pericardial effusion.

CONCLUSION

Transesophageal epicardial access and pericardial window seemed to be feasible and well tolerated in a porcine model, indicating the possibility of expanding mediastinal procedures conducted with endoscopy in the future.