Abstract
Background Both long-term proton pump inhibitor use and surgical fundoplication have potential drawbacks as treatments for chronic gastroesophageal reflux disease (GERD). Our aim was to investigate the potential efficacy of antireflux mucosectomy (ARMS) in porcine and determine the optimal circumference of resection in relation to gastroesophageal junction (GEJ). Methods Nine pigs were allocated into the following 3 groups by computerized randomization: group A: control, group B: 1/3 circumference of the esophagus, and group C: 2/3 circumference of the esophagus. We performed mucosectomy with a crescentic mucosal resection at 3 cm above the GEJ and 1 cm below the GEJ. The animals were kept on a liquid diet for 24 h prior to endoscopy. At 6 weeks, animals underwent esophagoscopy, barium radiography, gastric yield pressure (GYP), and gastric yield volume (GYV) determination. Results The weight of swines has no significant difference, and all pigs had maintained their weight after the procedure. We both found scar formation at the GEJ in group B and C. Compared with group A and B, group C produced significantly higher GYP (24.23 ± 3.42 mmHg, p = 0.004) and significantly smaller GYV (2200.0 ± 238.96 mL, p = 0.028) after 6 weeks. Barium radiography showed that the width of the cardia was narrower (13.73 ± 1.19 mm, p = 0.032) in group C after 6-week postprocedure. Conclusion Our study demonstrated the potential antireflux effect of ARMS. We also recommend the 2/3 circumference resection of mucosa at 3 cm distance from the GEJ.
Highlights
Gastroesophageal reflux disease (GERD) is a neuromuscular disorder with abnormal reflux of gastric contents into the esophagus [1]. It is a common disease in which mechanisms such as poor esophageal clearance, delayed gastric emptying, and low esophageal sphincter (LES) dysfunction, as a result of esophagogastric motility disorder [2]
As for the invasiveness of surgery, many endoscopic treatments have been developed as an alternative therapy, such as endoscopic anterior fundoplication, transoral incisionless fundoplication (TIF)
A total of nine pigs were enrolled in our study; 3 procedures per each group were successfully performed
Summary
Gastroesophageal reflux disease (GERD) is a neuromuscular disorder with abnormal reflux of gastric contents into the esophagus [1]. Antireflux surgery is the most effective therapy for prompting the symptom relief of GERD. As for the invasiveness of surgery, many endoscopic treatments have been developed as an alternative therapy, such as endoscopic anterior fundoplication, transoral incisionless fundoplication (TIF) These endoscopic devices have not yet withstood the test of clinical trials. Both long-term proton pump inhibitor use and surgical fundoplication have potential drawbacks as treatments for chronic gastroesophageal reflux disease (GERD). Our aim was to investigate the potential efficacy of antireflux mucosectomy (ARMS) in porcine and determine the optimal circumference of resection in relation to gastroesophageal junction (GEJ). The weight of swines has no significant difference, and all pigs had maintained their weight after the procedure We both found scar formation at the GEJ in group B and C. We recommend the 2/3 circumference resection of mucosa at 3 cm distance from the GEJ
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