Feasibility and effectiveness of laparoscopic transgastric stapler-assisted circumferential esophageal mucosectomy and simultaneous fundoplication in a pig model.
Feasibility and effectiveness of laparoscopic transgastric stapler-assisted circumferential esophageal mucosectomy and simultaneous fundoplication in a pig model.
复制标题
DOI：
10.1093/dote/doy030
复制
发表时间：
2018-10-01
期刊：
影响因子：
--
通讯作者：
Müller-Stich BP
中科院分区：
文献类型：
--
作者：
Steinemann DC;Müller PC;Schwarz AC;Zerz A;Linke GR;Müller-Stich BP
腹腔镜经胃吻合器辅助粘膜切除术 (SAM) 已被描述用于巴雷特食管 (BE) 的微创圆周整块切除术。可以想象，在 SAM 切除 BE 后添加抗反流手术可能会实现长期疾病控制。本研究的目的是评估在 6 头猪的一次腹腔镜手术中联合 SAM 和胃底折叠术的可行性。此外，在基线、SAM 后以及随后的腹腔镜胃底折叠术后对胃食管连接部 (GEJ) 的功能进行了评估。在每个测量点，每头猪的回流测量重复 6 次。将蓝色水注入胃中以引发反流。记录胃内屈服压力和体积直至排出蓝色溶液(DBS)。通过 DBS 和多通道腔内阻抗 (MII) 测量回流时间。 SAM 后的腹腔镜胃底折叠术对于所有动物来说都是可行的。 SAM 后发现 GEJ 减弱，表现为屈服压力、屈服体积、DBS 和 MII 时间下降（p=0.007、p<0.001、p<0.001 和 p=0.008）。添加尼森胃底折叠术后，GEJ 得到恢复。 GEJ 能力的测量值恢复到基线值。 （产量，p=0.11；DBS 时间，p=0.15；MII p=0.84）。 SAM 和胃底折叠术后，屈服压从基线时的 11.5 mmHg 增加至 19.7 mmHg (p<0.001)。腹腔镜胃底折叠术和 SAM 可以在一次腹腔镜手术中结合起来。尽管在 SAM Nissen 胃底折叠术后减弱，但在本实验中 GEJ 恢复为有效的反流屏障。需要临床验证来确认前瞻性人体试验的结果。
Laparoscopic transgastric stapler assisted mucosectomy (SAM) has been described for minimally invasive circumferential en-bloc resection of Barrett’s esophagus (BE). Conceivably long-term disease control might be achieved by adding anti-reflux surgery after resection of BE by SAM. The aim of this study was to assess the feasibility of combined SAM and fundoplication in one laparoscopic procedure in 6 pigs. Furthermore, the competence of the gastroesophageal junction (GEJ) was assessed at baseline, after SAM, and after subsequent laparoscopic fundoplication. At each measuring point reflux measurements were repeated 6 times in each pig. Blue-colored water was infused into the stomach for provocation of reflux. Intragastric yield pressure and volume until drainage of blue solution (DBS) were recorded. Time to reflux by DBS and by multichannel intraluminal impedance (MII) was measured. Laparoscopic fundoplication after SAM was feasible in all animals in a single-session. A weakening of the GEJ was found after SAM, indicated by decreased yield pressure, yield volume, time to DBS and MII (p=0.007, p<0.001, p<0.001 and p=0.008). After adding a Nissen-fundoplication the GEJ was restored. The measurements of the competence of the GEJ returned to baseline values. (Yield volume, p=0.11; time to DBS, p=0.15; MII p=0.84). The yield pressure increased from 11.5 mmHg at baseline to 19.7 mmHg after SAM and fundoplication (p<0.001). Laparoscopic fundoplication and SAM may be combined in a single laparoscopic session. Although weakened after SAM Nissen fundoplication restored the GEJ as an effective reflux barrier in this experiment. Clinical validation is needed to confirm the results in a prospective human trial.
登录
查看更多内容
影响因子：
9
作者：
Knight, Benjamin C.;Devitt, Peter G.;Thompson, Sarah K.
通讯作者：
Thompson, Sarah K.
影响因子：
24.5
作者：
Pouw, Roos E.;Seewald, Stefan;Bergman, Jacques J.
通讯作者：
Bergman, Jacques J.
影响因子：
--
作者：
Hamade, Nour;Sharma, Prateek
通讯作者：
Sharma, Prateek
影响因子：
9
作者：
Hofstetter, WL;Peters, JH;Bremmer, CG
通讯作者：
Bremmer, CG
影响因子：
24.5
作者：
Fitzgerald, Rebecca C.;di Pietro, Massimiliano;de Caestecker, John
通讯作者：
de Caestecker, John