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

## TL;DR

Researchers tested a new endoscopic technique in pigs to access the heart's outer lining, showing it is feasible and safe.

## Contribution

The study demonstrates a novel endoscopic approach for epicardial access and pericardial window in a porcine model.

## Key findings

- Catheters were successfully placed in the pericardial space without adverse events.
- A pericardial window was performed, effectively draining simulated pericardial effusion.
- The procedure was well tolerated and suggests potential for future mediastinal endoscopic procedures.

## Abstract

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.

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.

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.

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.