title: Electrical stimulation to increase lower esophageal sphincter pressure after POEM.
abstract: BACKGROUND
  Postoperative reflux remains to be a challenge for patients with achalasia undergoing Heller myotomy. Similarly, per-oral endoscopic myotomy (POEM) is gaining rapid acceptance but the impossibility of adding a fundoplication is questioned as the main pitfall to control reflux. Electrical stimulation of the lower esophageal sphincter (LES) has emerged as a new alternative for the treatment of reflux disease. The objective of this study was to evaluate the potential benefits of combining electrical stimulation with endoscopic esophageal myotomy to prevent post procedural reflux.
  
  
  METHODS
  Five pigs were subjected to POEM. After myotomy was completed, two electrical leads were implanted at the LES level and electrical stimulation was applied with the Endostim system with a regimen of 215 μs (5 mA amplitude), at 20 Hz for 25 min. LES pressures were recorded with manometry at pre and post-myotomy and after LES stimulation.
  
  
  RESULTS
  Myotomy was completed successfully in all cases. Mean pre-myotomy LES pressure was 35.99 ± 8.08 mmHg. After myotomy, the LES pressure significantly dropped to 10.60 ± 3.24 mmHg (p = 0.03). Subsequent to LES-EST, LES pressure significantly increased to 21.74 ± 4.65 mmHg (p = 0.01).
  
  
  CONCLUSIONS
  The findings of this study show that LES-EST in healthy animals increases LES pressure after POEM procedure, and could be useful tool to minimize gastroesophageal reflux.
authors.affiliation: Minimally Invasive Surgery Program, Favaloro University Hospital, Av Belgrano 1752, Buenos Aires, Argentina.
authors.forename: Franco
authors.initials: F
authors.lastname: Ciotola
authors.forename: Andres
authors.initials: A
authors.lastname: Ditaranto
authors.forename: Claudio
authors.initials: C
authors.lastname: Bilder
authors.forename: Adolfo
authors.initials: A
authors.lastname: Badaloni
authors.forename: Daniel
authors.initials: D
authors.lastname: Lowenstein
authors.forename: Juan Martin
authors.initials: JM
authors.lastname: Riganti
authors.forename: Toshitaka
authors.initials: T
authors.lastname: Hoppo
authors.forename: Blair
authors.initials: B
authors.lastname: Jobe
authors.forename: Fabio
authors.initials: F
authors.lastname: Nachman
authors.forename: Alejandro
authors.initials: A
authors.lastname: Nieponice
mesh_terms: D000818:Animals; D004599:Electric Stimulation Therapy; D004931:Esophageal Achalasia / Q000601:surgery*; D049630:Esophageal Sphincter, Lower; D005260:Female; D018662:Fundoplication / Q000379:methods; D005764:Gastroesophageal Reflux / Q000209:etiology / Q000517:prevention & control*; D008365:Manometry; D057605:Natural Orifice Endoscopic Surgery; D011183:Postoperative Complications / Q000517:prevention & control*; D034421:Sus scrofa; D016896:Treatment Outcome