Myotomy technique and esophageal contractility impact blown-out myotomy formation in achalasia: an in silico investigation
Myotomy technique and esophageal contractility impact blown-out myotomy formation in achalasia: an in silico investigation
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DOI：
10.1152/ajpgi.00281.2021
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发表时间：
2022-05-01
影响因子：
4.5
通讯作者：
Patankar, Neelesh A.
中科院分区：
文献类型：
--
作者：
Halder, Sourav;Acharya, Shashank;Patankar, Neelesh A.
我们使用计算机模拟模型来研究肌切开术的尺寸、收缩模式、食管-胃交界处（EGJ）的张力和肌切开术部位的肌肉组织对食管壁应力的影响，这些应力可能导致形成爆裂肌切开术（BOM）。我们用计算机模拟食管模型进行了三组模拟，其中肌切开术影响的区域被建模为没有肌纤维的椭圆形部分。这些数据集研究了肌切开术尺寸、不同食管收缩类型以及肌切开术受影响区域的不同食管胃交界处（EGJ）张力和壁硬度对可能导致BOM的食管壁应力的影响。发现更长的肌切开术伴随着在肌切开术部位累积的更高的团注体积。关于食管收缩，肌切开部位的变形最大，其次是扩张和痉挛，以及全食管加压。肌切开术部位的肌壁硬度更强的EGJ张力有助于增加肌切开术部位的变形。此外，我们发现，食管与较短的肌切开术表现更好地排空团比与较长的肌切开术。较短的肌切开术降低了BOM形成的机会。伴有EGJ流出道阻塞的扩张性胰腺炎形成BOM的机会最高。我们还发现，异常的残余EGJ张力可能是BOM发展的辅助因素，而肌切开术部位的残余肌纤维可降低BOM形成的风险。新&值得注意的是，爆裂性肌切开术（BOM）是肌切开术后观察到的并发症，用于治疗贲门失弛缓症。进行计算机模拟，以确定导致BOM形成的因素。我们发现，一个短的切开术，不是透壁的，并有一些完整的结构体系，减少BOM形成的风险。此外，我们发现胃底折叠术引起的食管胃交界处张力增高会增加BOM形成的风险。
We used in silico models to investigate the impact of the dimensions of myotomy, contraction pattern, the tone of the esophago-gastric junction (EGJ), and musculature at the myotomy site on esophageal wall stresses potentially leading to the formation of a blown-out myotomy (BOM). We performed three sets of simulations with an in silico esophagus model, wherein the myotomy-influenced region was modeled as an elliptical section devoid of muscle fibers. These sets investigated the effects of the dimensions of myotomy, differing esophageal contraction types, and differing esophagogastric junction (EGJ) tone and wall stiffness at the myotomy affected region on esophageal wall stresses potentially leading to BOM. Longer myotomy was found to be accompanied by a higher bolus volume accumulated at the myotomy site. With respect to esophageal contractions, deformation at the myotomy site was greatest with propagated peristalsis, followed by combined peristalsis and spasm, and pan-esophageal pressurization. Stronger EGJ tone with respect to the wall stiffness at the myotomy site was found to aid in increasing deformation at the myotomy site. In addition, we found that an esophagus with a shorter myotomy performed better at emptying the bolus than that with a longer myotomy. Shorter myotomies decrease the chance of BOM formation. Propagated peristalsis with EGJ outflow obstruction has the highest chance of BOM formation. We also found that abnormal residual EGJ tone may be a co-factor in the development of BOM, whereas remnant muscle fibers at myotomy site reduce the risk of BOM formation.NEW & NOTEWORTHY Blown-out myotomy (BOM) is a complication observed after myotomy, which is performed to treat achalasia. In silico simulations were performed to identify the factors leading to BOM formation. We found that a short myotomy that is not transmural and has some structural architecture intact reduces the risk of BOM formation. In addition, we found that high esophagogastric junction tone due to fundoplication is found to increase the risk of BOM formation.