Endoscopic augmentation of the esophagogastric junction with polymethylmethacrylate: durability, safety, and efficacy after 6 months in mini-pigs.
OBJECTIVE
Endoscopic augmentation of the esophagogastric junction (EGJ) with polymethylmethacrylate (PMMA) has been reported in an experimental short-term study. We assessed whether endoscopic augmentation of the EGJ with PMMA is durable, safe, and efficacious after 6 months in mini-pigs.


METHODS
Ten mini-pigs were studied under anesthesia. After a pilot study in two animals, eight mini-pigs underwent lower esophageal sphincter (LES) manometry and gastrostomy with measurement of gastric yield volume (GYV) and gastric yield pressure (GYP). Endoscopic implantation of PMMA was performed aiming for the submucosa of the EGJ. Six months later, LES manometry and GYV and GYP measurements were repeated and animals were sacrificed, followed by microscopic analyses of the EGJ.


RESULTS
Out of 32 implants (four per animal), 29 (91%) were identified as submucosal nodules postmortem. PMMA deposits were found at microscopic analysis in all animals and located as follows [mean (range)]: submucosa 61.5% (37.5-91%), muscularis propria 21.5% (0-58%), mucosa 11% (0-25%), and subserosa 6% (0-17%). Neither esophageal perforation nor death was observed. A significant increase in GYV (1,404 versus 905 ml; p = 0.02) and a borderline increase in GYP (8.1 versus 6.5 mmHg; p = 0.057) were detected 6 months later.


CONCLUSIONS
Endoscopic augmentation of the esophagogastric junction with PMMA was durable and had no complications after 6 months. However, the occurrence of implants in the subserosa requires technical refinement before use in clinical trials.
Fornari
Fernando
F
Post-Graduation Program: Sciences in Gastroenterology, School of Medicine, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, 2 masculine andar, Bairro Santana, Porto Alegre, RS, Brazil. FernandoFornari@gmail.com
Freitag
Carmen P F
CP
Duarte
Marcos E S
ME
Kruel
Cleber R P
CR
Thomé
Paulo R O
PR
Sanches
Paulo R S
PR
Meurer
Luise
L
Cerski
Carlos T Z
CT
Petzhold
Cesar Liberato
CL
Callegari-Jacques
Sidia M
SM
Barros
Sérgio G S
SG
D000818:Animals; D004195:Disease Models, Animal; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004943:Esophagogastric Junction / Q000601:surgery*; D004945:Esophagoscopy / Q000379:methods; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000601:surgery*; D005773:Gastroscopy / Q000379:methods; D008365:Manometry; D010865:Pilot Projects; D019904:Polymethyl Methacrylate / Q000494:pharmacology*; D011475:Prosthesis Failure; D019919:Prosthesis Implantation; D019651:Plastic Surgery Procedures / Q000379:methods*; D013552:Swine; D013556:Swine, Miniature; D013718:Tensile Strength; D016896:Treatment Outcome
D019904:Polymethyl Methacrylate