Evaluation of benzalkonium chloride chemoneurolytic proximal gastric vagotomy.
BACKGROUND
Transmucosal chemoneurolytic injection of benzalkonium chloride (BAC) has previously been shown to duplicate operative proximal gastric vagotomy (PGV) in controlling gastric acid secretion. In this study, BAC was evaluated as to efficacious dose, methods of delivery, and systemic toxicities.


METHODS
Sham celiotomy, operative PGV controls, transmucosal injections through a gastrotomy, and transserosal injections of BAC (saline controls, 0. 625, 1.25, 2.5, 5.0, 10 mg BAC/kg body wt) were administered to Sprague-Dawley rats. After 3 months the rats underwent Congo red testing (CRT), horseradish peroxidase (HRP) neuronal staining, and necropsy. The color density change of the gastric mucosa from basic to acidic demonstrated by the CRT at the time of necropsy was used to calculate the residual anatomic acid-secreting area. Prior to necropsy, subserosal HRP injections into the anterior and posterior stomach walls assayed vagal neuronal viability via retrograde axonal flow. Results were compared by an ANOVA.


RESULTS
The results demonstrated that 1.25-10 mg/kg transmucosal BAC replicated the results of operative PGV; 2.5 mg/kg was found to be the most effective dose. All injection groups including saline controls demonstrated similar diminished vagal retrograde axonal flow by HRP testing consistent with local BAC chemoneurolytic effects. No systemic toxic symptoms were observed after tail vein intravenous BAC 1.25, 2.5, and 5.0 mg/kg.


CONCLUSIONS
These efficacy studies have demonstrated BAC's potential utility in the performance of endoscopic transmucosal chemoneurolytic PGV.
El-Ghazzawy
A G
AG
Department of Surgery, St. Louis University, 3635 Vista, St. Louis, MO 63110-0250, USA.
Gupta
N
N
Swope
T J
TJ
Kulkarni
A D
AD
Panneton
W M
WM
Robinson
S M
SM
Niehoff
M L
ML
Kaminski
D L
DL
Andrus
C H
CH
D000818:Animals; D001370:Axonal Transport; D001548:Benzalkonium Compounds / Q000008:administration & dosage* / Q000633:toxicity; D003714:Denervation; D005744:Gastric Acid / Q000378:metabolism; D005753:Gastric Mucosa / Q000294:innervation* / Q000378:metabolism; D006735:Horseradish Peroxidase; D007267:Injections; D051381:Rats; D017207:Rats, Sprague-Dawley; D014629:Vagotomy, Proximal Gastric; D014630:Vagus Nerve / Q000187:drug effects* / Q000502:physiology
D001548:Benzalkonium Compounds; D006735:Horseradish Peroxidase