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.

Transoral Endoscopic Esophageal Myotomy Based on Esophageal Function Testing in a Survival Porcine Model / Perretta, S; Dallemagne, B; Donatelli, G; Diemunsch, P; Marescaux, J.. - In: GASTROINTESTINAL ENDOSCOPY. - ISSN 0016-5107. - 73:1(2011), pp. 111-116. [10.1016/j.gie.2010.09.009]

Transoral Endoscopic Esophageal Myotomy Based on Esophageal Function Testing in a Survival Porcine Model

Donatelli G;
2011

Abstract

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.
2011
Transoral Endoscopic Esophageal Myotomy Based on Esophageal Function Testing in a Survival Porcine Model / Perretta, S; Dallemagne, B; Donatelli, G; Diemunsch, P; Marescaux, J.. - In: GASTROINTESTINAL ENDOSCOPY. - ISSN 0016-5107. - 73:1(2011), pp. 111-116. [10.1016/j.gie.2010.09.009]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11588/885846
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