Electrocautery Snare Research Articles

Endobronchial Leiomyoma, an Unusual Tumor in an Unusual Site

Abstract Leiomyomas are benign smooth muscle tumors most commonly seen in the uterus occasionally in the gastrointestinal tract. Pulmonary localization is extremely rare with the incidence of <2%. We report the case of a 22-year-old nonsmoking female who presented with left-sided chest pain and streaky hemoptysis. Chest xray showed left lingular lobe and lower lobe collapse. Contrast-enhanced computed tomography showed endobronchial obstruction in the left main bronchus. Debulking was done with electrocautery snare. Histopathological examination showed spindle-shaped cells with eosinophilic cytoplasm. Immunohistochemistry showed smooth muscle actin positivity suggestive of leiomyoma. The patient is under follow-up without any complication and recurrence.

Novel use of hot biopsy forceps for removal of tracheobronchial stent-related granulation tissue

Patients with malignant central airway obstruction often present with dyspnea and sometimes with frank respiratory failure. Airway stenting has become a routine modality in the management of these patients. A correctly placed airway stent will give good relief in dyspnea and respiratory failure and will even improve the patient's ECOG (Eastern Cooperative Oncology Group) performance score. The common complications associated with stents are migration, fracture, infection, and obstruction by tumors, granulation tissue, and secretions. These complications are more pronounced with metallic stents. Surveillance bronchoscopy should ideally be done in these patients at least 4–6 weeks post-stent insertion. Removal of granulation tissue has been attempted with modalities like lasers, Argon plasma coagulation, cryotherapy, and snare electrocautery. Here, we present a novel case of post-stent granulation tissue, which was removed and debulked with the help of electrocoagulation bronchoscopy biopsy forceps (hot biopsy forceps).Conclusion Hot biopsy forceps can be safely and easily used for the removal of granulation tissue in patients post-tracheobronchial stent insertion.

Diagnostic and Therapeutic Role of Electrocautery Snare Use in Endobronchial Polypoid Lesions

IntroductionElectrocautery with a snare probe offers a tool for the treatment of endobronchial polyps. The aim of this study was to demonstrate the efficacy of the snare probe in patients undergoing rigid bronchoscopy due to central airway obstruction. MethodsThis retrospective descriptive study included patients who underwent rigid bronchoscopy with an electrocautery snare probe for the diagnosis and/or treatment of endobronchial polyps in an interventional pulmonology unit. ResultsThe mean age of the 47 patients (38 men) with endobronchial polypoid lesions was 61.5 years. Six lesions (12.8%) were located in the trachea, 6 (12.8%) in the right main bronchus, 11 (23.4%) in the left main bronchus, and 24 (51.1%) in the lobar bronchi. Twenty-eight lesions (59.5%) were malignant. Prior to the procedure, 6 (12.8%) patients had grade 1 obstruction, 6 (12.8%) had grade 2 obstruction, 15 (31.9%) had grade 3 obstruction, and 20 (42.6%) had grade 4 obstruction. In terms of airway obstruction after the procedure, grade 1 was present in 46 (97.9%) patients and grade 2 was present in 1 (2.1%) patient. No major complication developed in 93.6% of the patients. During a mean follow-up period of 48 months, 85.1% of the patients did not experience recurrence. ConclusionOur results demonstrate that the snare probe can be used to effectively and reliably establish airway patency in patients with central airway obstruction due to endobronchial polypoid lesions.

Benign inoperable tracheal stenosis in COVID versus non-COVID patients at the pandemic epicenter: a case series.

The COVID-19 pandemic has exponentially expanded the number of patients requiring treatment for chronic respiratory failure. One consequence is an increase in the number of patients requiring intubation and mechanical ventilation. Benign inoperable tracheal stenosis presents a challenge, especially in COVID-19 patients. We describe a case series of 15 patients with Benign inoperable tracheal stenosis treated with interventional bronchoscopy over a 15-month period. These patients were divided into two groups, COVID and non-COVID. We used an electrocautery snare as an electrocautery knife to cut the stenotic segment followed by four injections of 1mg submucosal Decadron via a Wang needle. Patients were subsequently followed by the pulmonary clinic. Institutional review board approval was not required as per our institutional policy for a retrospective case series. There was a high degree of success with this intervention, with a low rate of recurrence. We also noticed the following differences between the two subgroups. COVID tracheal stenosis was longer in length, had a higher percentage of cartilage involvement, and was located more distal to cords than the non-COVID group. The median age was younger in the COVID group. COVID pandemic an enormous number of intubations and tracheotomies have been performed. As a result, there will be an increased prevalence of tracheal stenosis. Most of these cases can be effectively treated with surgery. Dealing with complex inoperable cases remains a dilemma. Our case series/research article is an attempt to provide an easy technique with a high cure rate.

WEO Newsletter.

WEO Newsletter.

INTERMITTENT OBSTRUCTION: A CASE OF ENCAPSULATED ENDOBRONCHIAL HAMARTOMA EXHIBITING A CUP-IN-BALL EFFECT

INTERMITTENT OBSTRUCTION: A CASE OF ENCAPSULATED ENDOBRONCHIAL HAMARTOMA EXHIBITING A CUP-IN-BALL EFFECT

ENDOBRONCHIAL LIPOMA: SUCCESSFUL TREATMENT WITH ELECTROCAUTERY SNARING AND CRYOTHERAPY

ENDOBRONCHIAL LIPOMA: SUCCESSFUL TREATMENT WITH ELECTROCAUTERY SNARING AND CRYOTHERAPY

DOUBLE TROUBLE: CENTRAL AIRWAY OBSTRUCTION WITH HEMOPTYSIS FROM A METASTATIC YOLK SAC TUMOR

DOUBLE TROUBLE: CENTRAL AIRWAY OBSTRUCTION WITH HEMOPTYSIS FROM A METASTATIC YOLK SAC TUMOR

ALL THAT WHEEZES IS NOT ASTHMA: BRONCHIAL PAPILLOMA

ALL THAT WHEEZES IS NOT ASTHMA: BRONCHIAL PAPILLOMA

En bloc transurethral resection of bladder tumors: A review of current techniques

Growing interest surrounds the concept of en bloc transurethral resection of bladder tumors (ERBT). Theoretical advantages include improved adherence to oncological principles and potential yield of superior pathological specimens. Multiple ERBT methods exist. This review summarizes the current evidence regarding application of differing techniques and technologies to ERBT. A systematic review of MEDLINE/EMBASE/Scopus databases was performed, using terms "en bloc," "ERBT," "bladder," and "urinary bladder neoplasm." Template-based data extraction included technique of ERBT, feasibility, tumor size, activation of obturator nerve reflex, operative complications, detrusor muscle sampling rate, and recurrence data. Multiple approaches to ERBT have evolved, using a variety of energy sources. The feasibility of electrocautery, laser, combined waterjet/electrocautery, and polypectomy snare techniques have been confirmed in achieving ERBT. ERBT appears safe, with a low complication rate. The use of laser energy sources reduces the risk of activating the obturator nerve reflex during lateral wall resections. Otherwise, no energy source is unequivocally superior in achieving ERBT. The rate of detrusor muscle sampling is high with use of ERBT and appears superior to that achieved with conventional TURBT (cTURBT) in multiple comparative studies. A limited number of largely non-randomized trials assess bladder tumor recurrence; current evidence suggests this is similar between ERBT and cTURBT groups. ERBT using a variety of technologies is feasible and safe, with a high detrusor muscle sampling rate. Further research is required to determine whether rates of residual disease or recurrence can be reduced with ERBT vs. cTURBT.

Novel Method of Sampling the Gastrointestinal Muscle Layer: Feasibility of Endoscopic Muscular Resection with a Ligation Device in an in Vivo Porcine Model.

Gastrointestinal muscular sampling is useful in the histological assessment of functional gastrointestinal disorders. We devised a new sampling method to obtain a large volume of muscle tissues and then investigated the feasibility and safety of endoscopic muscular resection with a ligation device in an in vivo porcine model. After establishing a submucosal tunnel, a rubber band was placed on the muscle tissue by sucking the exposed muscle layer. Thereafter, the established pseudopolyp was removed using an electrocautery snare, and the entry site of the submucosal tunnel was closed endoscopically. This procedure was performed at three sites in the esophagus and stomach of two pigs. The technical success, histology, and survival rate on postoperative day 7 were examined postoperatively. We successfully completed the mentioned procedure in 11 of the 12 sites (92%), without the occurrence of severe adverse events. The median diameters of obtained tissues from the esophagus and stomach, respectively, were 5 mm and 10 mm. Histologically, both the inner and outer muscle layers were included in all specimens. The postprocedural course was found uneventful in both pigs during the observatory period. Endoscopic muscular resection using a ligation device enabled us to obtain large and thick muscle tissue samples. This approach may facilitate more precise histological assessments of functional gastrointestinal disorders.

Bronchoscopic Management of Endobronchial Atypical Carcinoid With Argon Plasma Coagulation and Laser: A Rare Case With Literature Review

Atypical carcinoid belongs to a spectrum of neuroendocrine tumors that can present as central airway obstruction. We treated a 58-year-old female who presented with recurrent pneumonia. Flexible bronchoscopy showed complete obstruction of the tumor in the right lower lobe. The tumor was excised by electrocautery snare followed by laser and argon plasma coagulation (APC). Endobronchial biopsy showed atypical carcinoid with lymph node metastasis. Succeeding bronchoscopic management, the patient’s symptoms improved. In our patient, bronchoscopy with laser and APC was performed to prevent tumor recurrence after resection and reduce the risk of recurrent postobstructive pneumonia. Surveillance computed tomography at six months showed no evidence of recurrence. Bronchoscopic management should be considered in poor surgical candidates or patients with metastatic disease.

TRACHEAL LIPOMA CAUSING NEAR COMPLETE OBSTRUCTION: A MULTI-MODAL TECHNIQUE FOR MANAGEMENT

SESSION TITLE: Fellows Procedures Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: Tracheal lipomas are a rare cause of major airway obstruction and account only for 0.1% to 0.5% of all lung tumors (1). Management of these has involved flexible or rigid bronchoscopy guided resection (1,2). Here we report a multi-modal approach to resection of a tracheal lipoma causing 80% obstruction of the distal trachea. CASE PRESENTATION: A 70-year-old male with 40 pack year cigarette smoking history and chronic obstructive pulmonary disease (COPD), had presented with progressively worsening dyspnea and wheezing. He had been using his prescribed budesonide/formoterol inhaler without significant relief. A CT-Chest without contrast showed a lesion in the distal trachea. An endobronchial tumor was suspected and evaluation with rigid bronchoscopy was planned. He was first intubated in an atraumatic fashion with the 12mm rigid bronchoscope. A vascular appearing polypoid tumor was protruding from the posterior membrane of the trachea and obstructed 80% of the lumen. Endobronchial ultrasound (EBUS) was used to examine the tumor further and it appeared solid without significant vascularity within the lesion. Rigid forceps were used for biopsy and the specimen was sent for frozen section analysis. Then electrocautery snare was used to remove the largest component of the tumor. Subsequently, Nd:YAG laser was used while holding ventilation to destroy the base of the tumor and left a crater like appearance. This was done with the intention to facilitate healing of the mucosa. The final pathology was consistent with a benign tracheal lipoma. DISCUSSION: Tracheal lipomas are 1.4–13.0% of benign tumors of the lung (1). Multiple cases in the literature report use of electrocautery or endobronchial lasers (1,2). Our approach involved using EBUS, which allowed us to examine the lesion to assess its margins and vascularity. Hemorrhage could prove to be fatal in a patient with high risk obstructive lesion. This method allowed a safe excision without significant bleeding. Furthermore, use of Nd:YAG laser achieved superior destruction of the tumor base which allowed for better healing of the mucosa. We do recommend using the laser at a low energy setting to avoid rare complications such as fire when used in high fat content lesions. A surveillance bronchoscopy 5 months following the procedure showed a completely healed posterior tracheal membrane with no evidence of recurrence. CONCLUSIONS: Combined use of rigid bronchoscopy, EBUS and Nd:YAG laser as a multi-modal approach to maximize safety while minimizing chances of recurrence should be considered. Reference #1: Stevic R, Milenkovic B. Tracheobronchial tumors. J Thorac Dis. 2016;8(11):3401-3413. doi:10.21037/jtd.2016.11.24 Reference #2: Pollefliet C, Peters K, Janssens A, et al. Endobronchial lipomas: rare benign lung tumors, two case reports. J Thorac Oncol. 2009;4(5):658-660. doi:10.1097/JTO.0b013e31819c9a59 DISCLOSURES: No relevant relationships by Brian Cody Adkinson, source=Web Response No relevant relationships by Sisir Akkineni, source=Web Response No relevant relationships by Sixto Arias, source=Web Response No relevant relationships by Jose Garcia Blanco, source=Web Response

A NOVEL TREATMENT APPROACH FOR A RARE TRACHEAL TUMOR

SESSION TITLE: Fellows Procedures Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: The differential diagnosis for tracheal tumors is broad and often requires direct endobronchial evaluation for management. Neoplastic tumors account for 10% of tracheal masses. Herein, we describe a rare adult tracheal tumor that was successfully treated bronchoscopically. CASE PRESENTATION: A 48 year-old non-smoking female with childhood asthma presented to pulmonary clinic with a chronic cough for 4 months despite multiple courses of antibiotics and steroid bursts for suspected bronchitis. Due to persistent symptoms, she ultimately underwent a computed tomography scan of the chest which revealed a 0.9x0.6x0.5 cm polypoid-like density at the tracheal carina. Initial endobronchial biopsies showed inflammatory cells without evidence of malignancy. Due to concern for sampling artifact, she underwent a flexible/rigid bronchoscopy with tumor excision by snare electrocautery, argon plasma coagulation, and cryotherapy. Pathologic examination revealed an inflammatory myofibroblastic tumor (IMT) without an ALK rearrangement. A tumor board recommended curative tracheal resection versus surveillance bronchoscopy and imaging. The patient opted for surveillance as her symptoms had resolved. She has had annual bronchoscopies without any evidence of recurrence, and she remains asymptomatic. DISCUSSION: IMTs are slow growing quasi-neoplastic lesions that mostly affect children under 16 years old and are rarely reported in adults, accounting for 0.04-0.07% of all lung neoplasms. Most commonly affecting the lungs, these tumors can also involve a multitude of different organs. The etiology remains unknown although it is theorized to arise from an inflammatory process like a prior infection, trauma or surgery. However, the ALK rearrangement, which has been noted in 50% of IMTs, suggests a possible neoplastic origin. Classic pathologic features include myxoid spindle myofibroblasts with abundant inflammatory cells of plasma cells, lymphocytes, and eosinophils. Up to 80% of patients are asymptomatic but few may present with symptoms suggestive of, and commonly mistaken for, asthma. IMT treatment typically requires surgical resection via thorascoscopy or thoractomy. Chemotherapy, ALK directed therapies, and/or steroids have been used in nonsurgical cases. Few case reports have described effective bronchoscopic resection. A case series of 7 patients reported successful resection with one recurrence. Unfortunately, due to the tumor’s rarity, no robust studies exist for evaluating bronchoscopic treatment. A bronchoscopic approach offers a minimally invasive and potentially curative option but requires regular follow up for recurrence. CONCLUSIONS: IMTs are rare adult tracheal tumors, and treatment often entails surgical tracheal resection, which carries significant peri-operative risks with prolonged recovery. This case of IMT was successfully treated by bronchoscopic resection with curative effect. Reference #1: Jain S, Chopra P, Agarwal A, et al. Inflammatory myofibroblastic tumor of trachea. J Bronchol Intervent Pulmonol 2013;20:80-83. Reference #2: Oztuna F, Pehlivanlar M, Abul Y, et al. Adult inflammatory myofibroblastic tumor of the trachea: case report and literature review. Respir Care 2013;58:e72-6. DISCLOSURES: Speaker/Speaker's Bureau relationship with Boehringer-Ingelheim Pharmaceuticals Please note: $5001 - $20000 Added 04/07/2020 by Jaime Betancourt, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with Vapotherm, Inc Please note: $5001 - $20000 Added 04/07/2020 by Jaime Betancourt, source=Web Response, value=Honoraria No relevant relationships by Tao He, source=Web Response No relevant relationships by Leeyen Hsu, source=Web Response No relevant relationships by Scott Oh, source=Web Response

Rare case of bronchoscopic debulking of endobronchial leiomyoma

An endobronchial leiomyoma is a rare benign tumour of lung. It occurs from the smooth muscle of tracheobronchial tree or within lung parenchyma. It presents less than 2% of all benign lung tumours. We present a case report of a 39-year-old male, ex-smoker, with no family history of malignancies, presenting with cough and dyspnoea for 7 months with no symptomatic relief. CAT scan thorax showed well-defined oblong soft tissue mass lesion 24.2 mm × 15.4 mm in right major bronchus compromising central lumen. Flexible bronchoscopy revealed an endobronchial mass at right major bronchus. Patient underwent rigid bronchoscopy with endobronchial mass excision with an electrocautery snare and cryoprobe in the same seating. Complete debulking of tumour was achieved and histopathology report was suggestive of leiomyoma. Prompt investigations and intervention can give favourable outcomes in cases of endobronchial tumours.

Aetiologic Diagnosis and the Efficacy of Interventional Treatment of Intraluminal Central Airway Spheroid Masses

<i>Objective</i> To explore the diagnosis of, clinical characteristics of and effects of interventional therapy for intraluminal central airway spheroid masses. <i>Methods</i> Forty-four patients with intraluminal central airway spheroid masses were summarized retrospectively, and the clinical characteristics and therapy were analysed. <i>Results</i> Cough and shortness of breath were the predominant symptoms, followed by hemoptysis, fever and chest pain. The aetiologic diagnoses were 12 cases of inflammatory granulomas, 5 cases of foreign matter, 5 cases of squamous carcinoma, 4 cases of leiomyoma, 3 cases of lipomyoma, 2 cases of inflammatory myofibroblastic tumor, and one case each of glomus tumor, adenocarcinoma, mucoepidermoid carcinoma, malignant melanoma metastasis, carcinoid, adenoid cystic carcinoma, chondrosarcoma, combined small cell carcinoma, hamartoma, mixed tumor, neurilemmoma, acidophilic adenoma and salivary gland tumor. The numbers of masses located in the trachea, left main bronchus, right main bronchus and bronchus intermedius were 20, 13, 7, and 4, respectively. Electrocautery snare and electrocoagulation probe was the most commonly used interventional therapy method, followed by argon plasma coagulation and cryotherapy; stent implantation was used in 1 case. Thirty-five cases achieved a complete response or partial response after treatment, 8 cases achieved a mild response, and 1 had no response. <i>Conclusion</i> The symptoms of intraluminal central airway spheroid masses were atypical and easily misdiagnosed or missed; benign lesions were the leading cause, and the first pathological type was inflammatory granuloma. Endoscopic intervention was the effective, safe technique.

Definitive therapy of colonic angioectasia by submucosal coagulation.

Background and study aims Colonic angioectasia are the most common vascular lesions in the gastrointestinal tract and are among the most common causes for chronic or recurrent lower gastrointestinal bleeding. Endoscopic treatment involves a variety of techniques, all of which focus on destruction of the mucosal abnormality. However, recurrent bleeding after endoscopic treatment is common, with more than one treatment frequently necessary. We report a technique for definitive treatment of colonic angioectasia by targeting the feeding submucosal vessel. Patients and methods Analogous to endoscopic mucosal resection, a submucosal injection is made beneath the target lesion which is then removed by electrocautery snare resection of the mucosal lesion. The exposed feeding vessel is then destroyed by application of coagulation current. The resection defect is closed by clips. Results Six patients with a total of 14 colonic angioectasia were treated over the study period. All lesions were destroyed without adverse events. Conclusion Elevation, hot snare resection and coagulation (ESC) of the visible vessel for treating colonic angioectasia appears safe and effective. Larger prospective comparative studies are required to assess its specific role.

Benign Endobronchial Inflammatory Polyp with Cystic Degeneration: A Case Report.

Endobronchial lesions causing luminal obstruction are mostly found in bronchogenic carcinoma. Inflammatory polyps originating from the tracheobronchial tree are rarely found. Here we report a case of an elderly male presenting with prolonged cough who was found to have an endobronchial inflammatory polyp. The polyp was resected completely with the use of the flexible bronchoscope and electrocautery snare.

PULMONARY HAMARTOMA PRESENTING AS CENTRAL AIRWAY OBSTRUCTION

SESSION TITLE: Medical Student/Resident Procedures SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Pulmonary hamartoma (PHM) is the most common benign tumor of the lung with a population incidence of 0.25% (1). Most PHM are intraparenchymal with only 10% being endobronchial (1). We report a case of endobronchial hamartoma presenting as left main stem (LMS) obstruction treated successfully with combination of snare electrocautery, cryotherapy debulking, and argon plasma coagulation (APC). CASE PRESENTATION: A 52-year old woman, never smoker, with history of cough-variant asthma presented with intermittent wheezing and dyspnea on exertion, presumed to be recurrent episodes of acute bronchitis or asthma. She failed a course of antibiotics and initiation of inhaled corticosteroids with beta 2 agonist therapy. Computed tomography (CT) of the chest demonstrated an ovoid mass predominantly in the left upper lobe bronchus (LUL) with partial extension to LMS and post obstructive collapse of the lingula (fig. 1). Hypoperfusion of the left lung was also evident. Bronchoscopy revealed obstruction of LMS bronchus by an endobronchial lesion (fig. 2). Complete excision of the lesion was performed using combination of snare electrocautery, cryotherapy debulking, and APC destruction of the tumor base, noted to be at the bifurcation of apico-posterior segment of the LUL. Histopathology revealed benign cartilage interspersed with a fibrovascular stroma and scattered bronchial glands, consistent with PHM (fig.3). The patient’s symptoms improved significantly following the intervention. She remains symptom-free on a 3-month follow up. DISCUSSION: Hamartomas are disorganized tumor masses composed of various tissues including fat, epithelium, cartilage, and fibrous stroma. PHMs are usually slow growing and most patients are asymptomatic. Classified as either intraparenchymal or endobronchial, the symptoms depend largely on the location of the tumor; small peripheral intraparenchymal tumors often remain asymptomatic for many years, however, endobronchial hamartomas may present as recurrent bronchitis due to post-obstructive inflammation, as did our patient. Chest radiograph may not reveal collapse despite significant obstruction due to air-trapping as a result of ball-valve phenomenon; however, CT chest is diagnostic. Additionally, hypo-perfusion of the under-ventilated lung may be observed due to perfusion shift to better aerated lung.Given their minimal potential for malignant transformation, PHMs are usually managed conservatively. Tumor debulking utilizing multimodal endoscopic ablative techniques, as in our patient, is the preferred modality in patients with symptomatic endobronchial disease (2). CONCLUSIONS: Endobronchial PHM, although a rare entity, should be considered in the differential diagnosis of patients presenting with chronic cough and/or wheezing. CT allows identification of the location and size of the lesion and bronchoscopic excision using multi-modality approach is therapeutic. Reference #1: 1. Ahmed S, Arshad A, Mador MJ. Endobronchial hamartoma; a rare structural cause of chronic cough. Respiratory medicine case reports. 2017;22:224-7. Reference #2: 2. Bilaceroglu S. Endobronchial Ablative Therapies. Clin Chest Med. 2018;39(1):139-48. DISCLOSURES: No relevant relationships by DIVYANSH BAJAJ, source=Web Response No relevant relationships by Rydhwana Hossain, source=Web Response No relevant relationships by Or Kalchiem-Dekel, source=Web Response No relevant relationships by Akshay Kohli, source=Web Response stock holder relationship with Opko Health, Inc Please note: $20001 - $100000 Added 03/02/2018 by Matthew Paparo, source=Web Response, value=dividends Audience for a educational course relationship with Pinnacle Biologics Please note: $1-$1000 Added 03/02/2018 by Matthew Paparo, source=Web Response, value=Honoraria No relevant relationships by Lynette Parker, source=Web Response No relevant relationships by Edward Pickering, source=Web Response No relevant relationships by Ashutosh Sachdeva, source=Web Response

Endoscopic muscle biopsy sampling of the duodenum and rectum: a pilot survival study in a porcine model to detect myenteric neurons

Small bowel and colorectal muscle biopsy sampling requires a surgical approach. Advancing our understanding of the pathophysiology of motility disorders, such as functional bowel disorders, intestinal pseudo-obstruction, and slow-transit constipation, is hindered by our inability to noninvasively obtain muscularis propria (MP) for evaluation of multiple cell types, including myenteric neurons. The aims of this study were to determine (1) technical feasibility, reproducibility, and safety of performing duodenal endoscopic muscle biopsy sampling (dEMB) and rectal endoscopic muscle biopsy sampling (rEMB) using a clip-assist technique and (2) the presence of myenteric neurons in tissue samples. Five 40-kg pigs were studied. Each animal underwent a dEMB and rEMB procedure. dEMB was performed using a single resection clip-assist technique. An over-the-scope clip was advanced to the duodenum. Tissue was suctioned into the cap and the clip deployed. The pseudopolyp of the duodenal wall created was then resected using snare electrocautery. rEMB was performed using a double resection clip-assist technique. EMR was initially performed to uncover the underlying MP using a band ligation technique. An over-the-scope clip was then advanced to the exposed MP. The MP was retracted and suctioned into the cap and the clip deployed. The pseudopolyp of the MP was resected using snare electrocautery. An antibody to protein gene product 9.5 was used to determine the presence of myenteric neurons in the samples. Animals were kept alive for 2 weeks, at which time an upper endoscopy and necropsy were performed. dEMB and rEMB were successfully performed in all animals with no procedural adverse events using this "no hole" (close then cut) approach. Mean procedure times for dEMB and rEMB were 23.7 ± 2.5 minutes and 13.25 ± 2.8 minutes, respectively. Mean length of resected full-thickness duodenal wall was 13.25 ± 4.3mm and rectal MP was 12.5 ± 1.7mm. Hematoxylin and eosin stain and antibody to protein gene product 9.5 confirmed the presence of MP with inner circular, outer longitudinal, and intermuscular layers, including myenteric neurons, in all samples. Clinical course was uneventful in all animals. Repeat upper endoscopy at 2 weeks showed well-healed dEMB sites. Necropsy in all animals showed no perforation, fluid collection, or abscess at the dEMB and rEMB sites. Based on this preclinical study, dEMB and rEMB appear to be technically feasible, reproducible, and safe. Sufficient MP tissue was obtained to identify myenteric neurons. These promising results are a step toward successful and safe implementation of these techniques into clinical practice for tissue diagnosis of muscle-based pathologies.