Endoscopic magnet placement into subadventitial tunnels for augmenting the lower esophageal sphincter using submucosal endoscopy: ex vivo and in vivo study in a porcine model (with video) - 21/01/19
Abstract |
Background and Aims |
Endolumenal therapies serve as a treatment option for GERD. This study aimed to determine if magnets could be placed endoscopically using the adventitial layer to create a subadventitial space near the esophagogastric junction to augment the lower esophageal sphincter using submucosal endoscopy.
Methods |
This study consisted of 2 phases, ex vivo and in vivo, with domestic pig esophagus. A long submucosal tunnel was made at the mid to lower esophagus. The muscularis propria was incised by a needle-knife within the submucosal tunnel. A subadventitial tunnel was made by biliary balloon catheter blunt dissection, and a magnet was deployed in the subadventitial space. The same maneuver was done within the opposing esophageal wall, with magnet placement in the opposing subadventitial space.
Results |
Submucosal tunnels and subadventitial tunnels were successful without perforation ex vivo in all attempts and in 9 of 10 cases, respectively. Magnets were deployed in the subadventitial space in 7 cases. Magnets connected and separated with atraumatic endoscope passage into the stomach and reconnected when the endoscope was withdrawn under fluoroscopy in 5 of 7 cases (71.4%). In vivo submucosal tunnels and subadventitial tunnels were successful in all 5 cases, and magnet augmentation was functionally active in 4 cases (80%).
Conclusion |
Subadventitial tunnels were feasible and could represent a new working space for endoscopic treatment. Endoscopic placement of magnets within the subadventitial space may be an attractive alternative endolumenal therapy for GERD.
Il testo completo di questo articolo è disponibile in PDF.Abbreviations : EGJ, LES, TTS
Mappa
| DISCLOSURE: The following authors disclosed financial relationships relevant to this publication: C. J. Gostout: Medical officer of Apollo Endosurgery; consultant for Olympus Japan. A. Dobashi: intellectual property, Medtronic. All other authors disclosed no financial relationships relevant to this publication. Research support for this study was provided by a Research Innovation Award 2016, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA. |
Vol 89 - N° 2
P. 422-428 - febbraio 2019 Ritorno al numero
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