Antireflux operations at flexible endoscopy using endoluminal stitching techniques: an experimental study.
BACKGROUND
Three antireflux operations-gastroplasty, fundoplication, and anterior gastropexy-were developed for performance at flexible endoscopy without laparotomy or laparoscopy.


METHODS
An endoscopic sewing machine mounted on a standard gastroscope, endoscopic knotting devices, overtube, and nylon thread were used to perform these operations in adult beagle dogs.


RESULTS
Gastroplasty (n = 10) was accomplished by suturing the anterior and posterior wall of the stomach to create a gastric tube (neoesophagus) along the lesser curve. An anatomic arrangement similar to fundoplication (n = 6) was achieved by invaginating the esophagus and fixing it to the stomach 2 cm distal to the cardioesophageal junction. Anterior gastropexy (n = 6) was performed using a technique similar to that used in creating percutaneous gastrostomies. There was no mortality. Ninety percent of sutures were seen at repeat endoscopy at 4 to 8 week intervals. The gastroplasty group was selected for more extensive evaluation. Manometry using a three-channel perfused catheter system before and after the procedures showed an increase in the lower esophageal sphincter pressure (preoperative median 4.6 mm Hg; post-operative median 13.33 mm Hg, p = 0.008) and cardiac yield pressures (preoperative median 10 mm Hg; postoperative median 19 mm Hg, p = 0.007).


CONCLUSIONS
This study demonstrates the feasibility of performing antireflux operations at flexible endoscopy, without laparoscopy or laparotomy, by use of endoluminal suturing techniques.
Kadirkamanathan
S S
SS
Gastrointestinal Science Research Unit, London Hospital Medical College, United Kingdom.
Evans
D F
DF
Gong
F
F
Yazaki
E
E
Scott
M
M
Swain
C P
CP
D000818:Animals; D004285:Dogs; D004724:Endoscopy / Q000379:methods*; D004943:Esophagogastric Junction / Q000503:physiopathology; D005260:Female; D018662:Fundoplication / Q000295:instrumentation*; D005764:Gastroesophageal Reflux / Q000503:physiopathology / Q000601:surgery*; D015391:Gastroplasty / Q000295:instrumentation*; D020699:Gastroscopes; D006801:Humans; D008365:Manometry; D009757:Nylons; D011312:Pressure; D013536:Suture Techniques
D009757:Nylons