title: Gastric acid secretion and gastrin release during continuous vagal neuromonitoring in thyroid surgery.
abstract: OBJECTIVE
  The vagus nerve (VN) has essential regulatory roles in the gastric acid secretion and gastrin release. Continuous intraoperative neuromonitoring (CIONM) via VN stimulation is a promising technique in thyroid surgery because it potentially avoids injury to the recurrent laryngeal nerve. However, no studies have investigated changes in gastric acid secretion and gastrin release during CIONM.
  
  
  METHODS
  This prospective study of 58 thyroid surgery patients compared gastric acid and serum gastrin at five time points: (1) before skin incision, (2) after baseline calibration of CIONM probe, (3) +20 min from baseline, (4) before probe removal, and (5) after extubation. Patients were excluded if they had any history of using tobacco, acid suppression medications, or drugs that affect gastric motility. Patients were also excluded if they had any history of gastroesophageal reflux symptoms, gastroesophageal reflux disease, peptic ulcer disease, helicobacter pylori infection, or chronic kidney disease.
  
  
  RESULTS
  Non significant differences in mean gastric pH values were observed at all time points, i.e., (1) before skin incision (2.2 ± 0.2; p = 0.50), (2) after baseline calibration of CIONM probe (2.0 ± 0.8; p = 0.62), (3) +20 min from baseline (2.5 ± 0.5; p = 0.24), (4) before probe removal (2.9 ± 0.9; p = 0.52), and (5) after extubation (2.6 ± 1.0; p = 0.60). Comparisons of pH monitoring parameters revealed no significant differences in age, gender, side of CIONM (left vs. right), sequence of CIONM, or duration of CIONM. Gastrin values were normal in sequential determinations and did not significantly differ at any time points.
  
  
  CONCLUSIONS
  CIONM performed via VN stimulation during total thyroidectomy in healthy patients does not influence gastrin secretion and gastric pH.
authors.affiliation: Jilin Provincial Key Laboratory of Surgical Translational Medicine, Division of Thyroid Surgery, Japan Union Hospital of Jilin University, Changchun city, Jilin Province, China.
authors.forename: Liu
authors.initials: L
authors.lastname: Xiaoli
authors.affiliation: Department of Otolaryngology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan.
authors.forename: Che-Wei
authors.initials: CW
authors.lastname: Wu
authors.affiliation: Department of Surgery, Division of Breast and Endocrine Surgery, Minimally Invasive Surgery and Robotic Surgery Center, Anam Hospital, KUMC Thyroid Center Korea University, Seoul, South Korea.
authors.forename: Hoon Yub
authors.initials: HY
authors.lastname: Kim
authors.affiliation: Department of General Surgery, The Chinese People's Liberation Army General Hospital, Beijing, China.
authors.forename: Wen
authors.initials: W
authors.lastname: Tian
authors.affiliation: Department of Otolaryngology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan.
authors.forename: Feng-Yu
authors.initials: FY
authors.lastname: Chiang
authors.affiliation: The Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Rd., Guangzhou, 510630, China.
authors.forename: Renbin
authors.initials: R
authors.lastname: Liu
authors.affiliation: Department of Surgery, Police General Hospital, Faculty of Medicine, Siam University, Pathumwan, Bangkok, Thailand.
authors.forename: Angkoon
authors.initials: A
authors.lastname: Anuwong
authors.affiliation: Division of Thyroid and Parathyroid Endocrine Surgery, Department of Laryngology and Otology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA.
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Randolph
authors.affiliation: 1st Division of General Surgery, Research Center for Endocrine Surgery, Department of Surgical Sciences and Human Morphology, University of Insubria (Varese-Como), via Guicciardini 9, 21100, Varese, Italy.
authors.forename: Gianlorenzo
authors.initials: G
authors.lastname: Dionigi
authors.affiliation: 1st Division of General Surgery, Research Center for Endocrine Surgery, Department of Surgical Sciences and Human Morphology, University of Insubria (Varese-Como), via Guicciardini 9, 21100, Varese, Italy. lavazza.matteo@gmail.com.
authors.forename: Matteo
authors.initials: M
authors.lastname: Lavazza
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005744:Gastric Acid / Q000378:metabolism*; D005745:Gastric Acidity Determination; D005755:Gastrins / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D011446:Prospective Studies; D013959:Thyroid Diseases / Q000378:metabolism / Q000601:surgery*; D013965:Thyroidectomy; D014630:Vagus Nerve / Q000502:physiology; D055536:Vagus Nerve Stimulation; D055815:Young Adult
chemical_list: D005755:Gastrins
keywords: C-IONM; Gastric acid; Gastrin release; Thyroid surgery; Vagal nerve