title: Peroral endoscopic pyloromyotomy accelerates gastric emptying in healthy pigs: proof of concept.
abstract: BACKGROUND
  Gastroparesis, or delayed gastric emptying, can be diagnosed with gastric emptying scintigraphy. Manometric studies of patients with gastroparesis show increased pyloric tone (pylorospasm). Among the recent endoscopic therapies for pylorospasm is peroral endoscopic pylorotomy (POP). In this study, we explored the effect of POP on gastric emptying in healthy pigs.
  
  
  METHODS
  Four mini-pigs underwent POP following general anaesthesia. The mucosal entrance was situated 5 cm above the pylorus. POP was performed through a submucosal tunnel dissection. The duration of gastric emptying was assessed by scintigraphy before and after the procedure. The pigs were then euthanised for necropsy and pathologic assessment of the pylorus.
  
  
  RESULTS
  The mean duration of the procedure was 55 (± 4 SD) min. All surgeries were performed in their entirety with 100 % feasibility. There were no cases of bleeding. The one case of perforation had no clinical significance. The duration of gastric emptying was 2.22-fold shorter after POP compared with before POP (T½ post-POP = 84.5 [± 35.7 SD] min vs. T½ pre-POP = 188.4 [± 87.3 SD] min; P = 0.029). In agreement with the endoscopic observations, sectioning of the pyloric muscle in each pig was histologically complete.
  
  
  CONCLUSIONS
  The efficacy of the procedure provides indirect proof of the involvement of the pyloric ring in delayed gastric emptying and suggests new therapies for patients with gastroparesis. Our protocol combining gastric emptying scintigraphy and POP validated the use of anaesthetised mini-pigs as a learning and training model for POP or other endoscopic/surgical procedures related to gastric emptying.
authors.affiliation: service d'hépato-gastro-entérologie, CHU Dupuytren, Limoges, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Geyl
authors.affiliation: service d'hépato-gastro-entérologie, CHU Dupuytren, Limoges, France.
authors.forename: Romain
authors.initials: R
authors.lastname: Legros
authors.affiliation: service d'anatomopathologie, CHU Dupuytren, Limoges, France.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Charissou
authors.affiliation: service d'anatomopathologie, CHU Dupuytren, Limoges, France.
authors.forename: Laura
authors.initials: L
authors.lastname: Mesturoux
authors.affiliation: laboratoire de recherche et d'analyses de la Haute-Vienne, Limoges, France.
authors.forename: Claude-Yves
authors.initials: CY
authors.lastname: Couquet
authors.affiliation: service d'hépato-gastro-entérologie, CHU Dupuytren, Limoges, France.
authors.forename: Paul
authors.initials: P
authors.lastname: Carrier
authors.affiliation: service d'hépato-gastro-entérologie, CHU Dupuytren, Limoges, France.
authors.forename: Anaïs
authors.initials: A
authors.lastname: Brayette
authors.affiliation: service d'hépato-gastro-entérologie, CHU Dupuytren, Limoges, France.
authors.forename: Zora
authors.initials: Z
authors.lastname: El-Ouafi
authors.affiliation: service d'hépato-gastro-entérologie, CHU Dupuytren, Limoges, France.
authors.forename: Veronique
authors.initials: V
authors.lastname: Loustaud-Ratti
authors.affiliation: service d'hépato-gastro-entérologie, CHU Dupuytren, Limoges, France.
authors.forename: Denis
authors.initials: D
authors.lastname: Sautereau
authors.affiliation: service de médecine nucléaire, CHU Dupuytren, Limoges, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Monteil
authors.affiliation: service d'hépato-gastro-entérologie, CHU Dupuytren, Limoges, France.
authors.forename: Jérémie
authors.initials: J
authors.lastname: Jacques