Transoral endoscopic esophageal myotomy based on esophageal function testing in a survival porcine model

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• 作者：Silvana Perretta ; Bernard Dallemagne ; Gianfranco Donatelli ; Pierre Diemunsch ; Jacques Marescaux
• 刊名：Gastrointestinal Endoscopy
• 出版年：2011
• 出版时间：January 2011
• 年：2011
• 卷：73
• 期：1
• 页码：111-116
• 全文大小：1392 K

文摘

Background

The most effective treatment of achalasia is Heller myotomy.

Objective

To explore a submucosal endoscopic myotomy technique tailored on esophageal physiology testing and to compare it with the open technique.

Design

Prospective acute and survival comparative study in pigs (n = 12; 35 kg).

Setting

University animal research center.

Intervention

Eight acute—4 open and 4 endoscopic—myotomies followed by 4 survival endoscopic procedures.

Main Outcome Measurements

Preoperative and postoperative manometry; esophagogastric junction (EGJ) distensibility before and after selective division of muscular fibers at the EGJ and after the myotomy was prolonged to a standard length by using the EndoFLIP Functional Lumen Imaging Probe (Crospon, Galway, Ireland).

Results

All procedures were successful, with no intraoperative and postoperative complications. In the survival group, the animals recovered promptly from surgery. Postoperative manometry demonstrated a 50 % drop in mean lower esophageal sphincter pressure (LESp) in the endoscopic group (mean preoperative LESp, 22.2 ± 3.3 mm Hg; mean postoperative LESp, 11.34 ± 2.7 mm Hg; P< .005) and a 69 % loss in the open procedure group (mean preoperative LESp, 24.2 ± 3.2 mm Hg; mean postoperative LESp, 7.4 ± 4 mm Hg; P < .005). The EndoFLIP monitoring did not show any distensibility difference between the 2 techniques, with the main improvement occurring when the clasp circular fibers were taken.

Limitations

Healthy animal model; small sample.

Conclusion

Endoscopic submucosal esophageal myotomy is feasible and safe. The lack of a significant difference in EGJ distensibility between the open and endoscopic procedure is very appealing. Were it to be perfected in a human population, this endoscopic approach could suggest a new strategy in the treatment of selected achalasia patients.