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.
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 achalasiapatients.
Authors: Stavros N Stavropoulos; David J Desilets; Karl-Hermann Fuchs; Christopher J Gostout; Gregory Haber; Haruhiro Inoue; Michael L Kochman; Rani Modayil; Thomas Savides; Daniel J Scott; Lee L Swanstrom; Melina C Vassiliou Journal: Surg Endosc Date: 2014-06-17 Impact factor: 4.584
Authors: Ezra N Teitelbaum; Lubomyr Boris; Fahd O Arafat; Frédéric Nicodème; Zhiyue Lin; Peter J Kahrilas; John E Pandolfino; Nathaniel J Soper; Eric S Hungness Journal: Surg Endosc Date: 2013-09-17 Impact factor: 4.584
Authors: Pietro Familiari; Giovanni Gigante; Michele Marchese; Ivo Boskoski; Vincenzo Bove; Andrea Tringali; Vincenzo Perri; Graziano Onder; Guido Costamagna Journal: United European Gastroenterol J Date: 2014-04 Impact factor: 4.623
Authors: Erwin Rieder; Lee L Swanström; Silvana Perretta; Johannes Lenglinger; Martin Riegler; Christy M Dunst Journal: Surg Endosc Date: 2012-09-06 Impact factor: 4.584