Esophageal Fluid Research Articles

Non-Acid Fluid Exposure and Esophageal Squamous Cell Carcinoma.

Esophageal squamous cell carcinoma (ESCC) accounts for the large majority of esophageal cancer cases worldwide. In this review, we examine the potential role of non-acidic fluid (NAF) exposure in ESCC carcinogenesis. Esophageal NAF consists of a mixture of salivary, esophageal, gastric, and duodenal fluids, containing inflammatory constituents such as digestive enzymes and bile acids that induce DNA damage, as well as known carcinogens such as acetaldehyde and N-nitrosamines. Exposure to NAF can occur in the setting of increased non-acid reflux, decreased gastric acidity, and decreased esophageal fluid clearance. Non-acid reflux has been associated with ESCC in small observational studies, and in animal models bile reflux can promote the development of ESCC. Associations have been found between increased ESCC risk and atrophic gastritis, a history of partial gastrectomy, and proton pump inhibitor use, all of which raise the pH of refluxate. Additionally, a minimally or non-acidic gastric environment contains an altered microbiome that can increase the production of acetaldehyde and N-nitrosamines. Esophageal motility disorders such as achalasia and opioid-induced esophageal dysfunction result in increased stasis and exposure to these potentially proinflammatory constituents of NAF. NAF may promote the development of ESCC via multiple mechanisms and is an understudied area of research.

Computed tomographic features of gastric and esophageal content in dogs undergoing CT myelography and factors influencing the presence of esophageal fluid.

BackgroundGastroesophageal reflux (GER) has been reported to be a common finding in dogs under general anesthesia.ObjectivesThe aim of this retrospective study was to assess the esophageal and gastric contents in a population of dogs undergoing computed tomographic myelography (myelo-CT) examination and to evaluate the factors influencing the presence of esophageal fluid (gastric content, duration of anesthesia, body position, and intrinsic factors).MethodsEsophageal and gastric contents of 83 non-brachycephalic dogs were retrospectively assessed based on plain and myelo-CT scans. Age, weight, breed, sex, and the time between the 2 computed tomography [CT] scans were included.ResultsEsophageal fluid was present in 19% (16/83) of the animals, and 14% (12/83) and 46% (37/83), respectively, had fluid or food material in their stomachs. The frequency of observing esophageal fluid on myelo-CT scans was significantly increased compared with plain CT scans (p = 0.006). The presence of gastric fluid was significantly associated with an increased frequency of observing esophageal fluid compared to other gastric contents (p = 0.049; odds ratio, 3.1). The presence of esophageal fluid was not correlated with alimentary gastric contents (p = 0.17). Increased body weight and duration of anesthesia were significantly associated with an increased frequency of observing esophageal fluid (p = 0.022, p = 0.021).ConclusionsUnlike alimentary gastric contents, fluid gastric contents were correlated with the presence of esophageal fluid upon myelo-CT. The observation of fluid in the esophagus may be consistent with GER. This study provides data additional to pH monitoring studies of GER and may support previous studies recommending shorter pre-anesthetic fasting periods in dogs.

Prenatal ultrasound diagnosis of esophageal diverticulum in the III trimester of gestation

The article presents a clinical case of prenatal diagnosis of esophageal diverticulum. In the study of ultrasound anatomy of the fetus at 32 weeks of gestation in the posterior mediastinum the anechogenic formation of a round shape with smooth clear contours, size 9.6 7.2 9.0 mm, avascular in colour Doppler mapping was detected. Ultrasound examination of the fetus at 36 weeks of gestation revealed a connection between the esophageal and cystic formation. This connection appeared during the filling of the esophageal amniotic fluid, which allowed the diagnosis of esophageal diverticulum. At 39 weeks of gestation occurred a spontaneous birth. The boy was born in full-term with weigh 3480 g. The prenatal diagnosis was confirmed during postnatal examination. The child is under the supervision of a surgeon. Surgical treatment is planned at the age of 6 months. The article discusses issues related to differential prenatal diagnosis of cystic masses of the mediastinum, prognosis and potential complications of the diverticulum of esophagus.

Evaluation of Gastroesophageal Reflux in Anesthetized Dogs with Brachycephalic Syndrome.

Brachycephalic airway syndrome may predispose to gastroesophageal reflux (GER) because of the high negative intrathoracic pressures required to overcome conformational partial upper airway obstruction. To investigate this, 20 dogs presenting for elective correction of brachycephalic airway syndrome (cases) and 20 non-brachycephalic dogs (controls) undergoing other elective surgeries were prospectively enrolled. Dogs underwent a standardized anesthetic protocol, and esophageal pH was monitored. Signalment, body weight, historical gastrointestinal and respiratory disease, complete blood count, serum biochemical values, radiographic findings, and anesthetic and surgical time were compared between cases and controls, and dogs that did and did not have basic (pH > 7.5), acidic (pH < 4), or any GER. Controls had higher mean esophageal pH (6.3) compared to cases (5.6, P = .019), but there was no difference in % with GER (cases 60%, controls 40%, P = .34). When all dogs were evaluated, dogs with GER had increased creatinine (P = .01), % positive for esophageal fluid on radiographs (P = .05), and body weight (P = .04) compared to those without GER. GER was common in both cases and controls, and cases had lower esophageal pH; however, greater numbers are required to determine if a true difference exists in % GER.

Local chemokine profiling in eosinophilic esophagitis: The synthetic absorptive matrix test

Summary We describe a novel method of sampling the esophageal lining fluid in children and show that levels of eotaxin-1 and MCP-4 differentiate those children with a histological diagnosis of EoE from those without. This article is protected by copyright. All rights reserved.

Post-mortem evaluation of drowning with whole body CT

PurposeThe aim of this study is to investigate the value of whole body computed tomography (WB-CT) in bodies recovered from water by analysis of the imaging findings after drowning. MethodsThe bodies of 41 drowning victims and 9 persons who died from mechanical asphyxia by hanging underwent post-mortem whole body computed tomography. Results and conclusionsExcessive fluid in the paranasal sinuses (98%), nasal pharynx (98%), oropharynx (95%), trachea (83%), ground glass opacities in the lung (89%), pleural fluid (71%), pericardial fluid (59%), esophageal fluid (81%), stomach fluid and distension (71%), duodenal (34%) and jejunal distension (31%) were the most frequent drowning related imaging findings which significantly differed from the group of mechanical asphyxia by hanging. In cases of fresh water drowning hemodilution was present in 79%. New and up to now unpublished findings were lower density in the spleen, indicative for hemodilution and detection of a pronounced amount of pericardial fluid, only seen in drowning victims.

Esophageal assessments of left ventricular filling pressures: A proof-of-concept study.

Objective:We sought to evaluate if left ventricular filling pressures can be assessed from the esophagus.Background:The invasive assessment of left ventricular filling pressures is of importance in the evaluation and monitoring of critically ill patients. The left atrium is in very close proximity to the esophagus. We hypothesized that the temporal pressure decay characteristics of an esophageal fluid volume positioned at the level ofthe left atrium should depend on the atrial and left ventricular filling pressure.Materials and Methods:In five pigs an esophageal balloon was placed at the level ofthe left atrium. The balloon was then pressurized to 50 mmHg followed by an automated release that allowed us to directly record the pressure decay, while simultaneously recording left atrial pressures. An algorithm was developed to estimate atrial pressures. We also tested if invasive transesophageal atrial pressures can be recorded via an ultrasound guided left atrial puncture.Results:Noninvasive transesophageal assessments of left atrial pressures are feasible. The left atrial pressure directly affects the esophageal pressure decay and correlates with the transition point from an exponential pressure decay to a more linear decay (r = 0.949). This approach also allows for the assessment of atrial waveforms. We could also demonstrate that invasive transesophageal pressure measurements are feasible and safe.Conclusions:The esophagus allows for reproducible less invasive assessments of left ventricular filling pressures and atrial pressure waveforms. This close spatial relationship provides an alternative access site for diagnostic and therapeutic cardiac procedures.

Impedance measurements and high-resolution manometry help to better define rumination episodes

Background. Rumination syndrome is a disorder of unknown etiology characterized by regurgitation of recently ingested food. We aimed to improve the diagnosis of rumination syndrome by classification of separate rumination symptoms using (1) an ambulatory manometry/impedance (AMIM) measurement and (2) a single-catheter high-resolution manometry/impedance (HRIM) measurement. Methods. A total of 96 symptoms during AMIM and 37 symptoms during HRIM were analyzed in five patients with clinically diagnosed rumination syndrome. Key results. AMIM identified rumination events in 85 out of 96 reported symptoms (symptom index (SI): 89%). Of these events, 63% were non-acidic and would have been missed by pH-metry. HRIM identified 32 out of 37 reported symptoms (SI: 86%). Upper esophageal sphincter (UES) relaxation was observed during all rumination events identified by HRIM and could be an additional criterion in the definition of rumination events. Conclusions. Impedance measurement and high-resolution manometry contribute to a more detailed description of rumination events. Rumination events defined as gastric strain, common cavity phenomenon, retrograde esophageal fluid flow, and UES relaxation show a high SI when measured with AMIM or single-catheter HRIM.

IL-25-Induced Immunotherapy Against Obesity and the Associated Metabolic Syndrome

Background/Aim: UES contractile reflex was described in 1957 by Creamer and Schlegel. The physiological role of this reflex in preventing pharyngeal reflux of gastric content and protecting the airway has been studied extensively. However, to date the defect of this reflex has not been described. Our aim was to characterize the UES pressure response to a variety of esophageal distensions in a group of patients with complaints of regurgitation and refluxattributed supraesophageal complications. Methods: We studied 8 patients (51 ± 20 yrs., 2F) with complaints of regurgitation and supraesophageal symptoms as well as 12 healthy asymptomatic controls (25 ± 5 yrs., 6F) in the supine position. Of the 8 patients, 6 had an intact esophagus, 1 had colonic interposition, and 1 had a partial esophagectomy and gastric pull-up. We tested the UES response to esophageal distension; simulating GE reflux by rapid and slow infusion of normal saline (10, 20, 30, and 60 mL) and air (10, 20, 30, 50 mL) and each injection was repeated 3 times. UES and esophageal pressures were monitored by high resolution intraluminal manometry. Pharyngeal reflux/regurgitation was monitored by high resolution esophagopharyngeal impedance recording. Patients were instructed to signal if pharyngeal reflux was perceived. Results: There were significant differences in the UES response to rapid and slow fluid injections between patients and controls (Chi-square< 0.0001) (Table). All patients but none of the controls reported pharyngeal reflux during slow and rapid esophageal fluid infusion. UES contraction(C) was absent during slow infusion only in patient group. Pharyngeal reflux was documented by impedance in six of eight patients with intact esophagus. All rapid fluid infusions produced UES contraction in the control group, while only 70-75% of rapid fluid infusions produced a UES contraction in patients. UES response to air distension, however, was relaxation(R) in both groups. Conclusions: UES contractile response to slow esophageal fluid distention is defective in patients with complaints of regurgitation and supraesophageal complications, allowing escape of refluxate into the pharynx. UES response to esophageal slow fluid infusion can serve as a test for recognizing this defect.

Glial Cell Line Derived Neurotrophic Factor Prevents High Fat Diet Induced Obesity

Background/Aim: UES contractile reflex was described in 1957 by Creamer and Schlegel. The physiological role of this reflex in preventing pharyngeal reflux of gastric content and protecting the airway has been studied extensively. However, to date the defect of this reflex has not been described. Our aim was to characterize the UES pressure response to a variety of esophageal distensions in a group of patients with complaints of regurgitation and refluxattributed supraesophageal complications. Methods: We studied 8 patients (51 ± 20 yrs., 2F) with complaints of regurgitation and supraesophageal symptoms as well as 12 healthy asymptomatic controls (25 ± 5 yrs., 6F) in the supine position. Of the 8 patients, 6 had an intact esophagus, 1 had colonic interposition, and 1 had a partial esophagectomy and gastric pull-up. We tested the UES response to esophageal distension; simulating GE reflux by rapid and slow infusion of normal saline (10, 20, 30, and 60 mL) and air (10, 20, 30, 50 mL) and each injection was repeated 3 times. UES and esophageal pressures were monitored by high resolution intraluminal manometry. Pharyngeal reflux/regurgitation was monitored by high resolution esophagopharyngeal impedance recording. Patients were instructed to signal if pharyngeal reflux was perceived. Results: There were significant differences in the UES response to rapid and slow fluid injections between patients and controls (Chi-square< 0.0001) (Table). All patients but none of the controls reported pharyngeal reflux during slow and rapid esophageal fluid infusion. UES contraction(C) was absent during slow infusion only in patient group. Pharyngeal reflux was documented by impedance in six of eight patients with intact esophagus. All rapid fluid infusions produced UES contraction in the control group, while only 70-75% of rapid fluid infusions produced a UES contraction in patients. UES response to air distension, however, was relaxation(R) in both groups. Conclusions: UES contractile response to slow esophageal fluid distention is defective in patients with complaints of regurgitation and supraesophageal complications, allowing escape of refluxate into the pharynx. UES response to esophageal slow fluid infusion can serve as a test for recognizing this defect.

Differential activation of pontomedullary nuclei by acid perfusion of different regions of the esophagus

The objective of this study was to determine the brain stem nuclei and physiological responses activated by esophageal acidification. The effects of perfusion of the cervical (ESOc), or thoracic (ESOt) esophagus with PBS or HCl on c- fos immunoreactivity of the brain stem or on physiological variables, and the effects of vagotomy were examined in anesthetized cats. We found that acidification of the ESOc increased the number of c -fos positive neurons in the area postrema (AP), vestibular nucleus (VN), parabrachial nucleus (PBN), nucleus ambiguus (NA), dorsal motor nucleus (DMN), and all subnuclei of the nucleus tractus solitarius (NTS), but one. Acidification of the ESOt activated neurons in the central (CE), caudal (CD), dorsomedial (DM), dorsolateral (DL), ventromedial (VM) subnuclei of NTS, and the DMN. Vagotomy blocked all c- fos responses to acid perfusion of the whole esophagus (ESOw). Perfusion of the ESOc or ESOt with PBS activated secondary peristalsis (2P), but had no effect on blood pressure, heart rate, or respiratory rate. Perfusion of the ESOc, but not ESOt, with HCl activated pharyngeal swallowing (PS), profuse salivation, or physiological correlates of emesis. Vagotomy blocked all physiological effects of ESOw perfusion. We conclude that acidification of the ESOc and ESOt activate different sets of pontomedullary nuclei and different physiological responses. The NTSce, NTScom, NTSdm, and DMN are associated with activation of 2P, the NTSim and NTSis, are associated with activation of PS, and the AP, VN, and PBN are associated with activation of emesis and perhaps nausea. All responses to esophageal fluid perfusion or acidification are mediated by the vagus nerves.

Technical limitations in detection of gastroesophageal reflux in neonates.

Characterize the incidence and possible etiologies of acid reflux events detected by pH and not identified by multiple intraluminal impedance (MII) monitoring. Acid reflux events detected by pH but not identified by MII (pH-only) were documented in 80 preterm and 39 term infants. Reasons for failure of MII to detect these events were classified as failure to meet MII scoring criteria, presence of an air bolus, technical artifact, and no change in impedance. Events with no change in impedance were stratified to low impedance throughout the study (possible esophageal inflammation), transient decrease in pre-event impedance (presence of refluxate), occurrence <30 seconds of a preceding event, and no explanation. A total of 2572 events were detected by pH, with 59% of events not identified by MII. A higher incidence of pH-only events occurred in preterm versus term infants (54 +/- 27% versus 42 +/- 23%, P = .025, respectively). Thirteen percent of pH-only events were missed due to MII scoring criteria, 12% due to technical artifact, 11% due to an air bolus, and 64% had no change in impedance. Of the 978 events with no change in impedance, 154 were associated with low impedance throughout the study, 430 with a transient decrease in pre-event impedance, and 175 were preceded by a reflux episode within 30 seconds. There was a high incidence of acid reflux events detected by pH but not identified by MII. This occurred more often in the least mature infants, and we speculate that delayed esophageal fluid clearance is the major underlying mechanism.

Oesophageal seal of the novel supralaryngeal airway device I-Gel™ in comparison with the laryngeal mask airways Classic™ and ProSeal™ using a cadaver model

BackgroundSupraglottic airway devices are increasingly used in anaesthesia and emergency medicine. This study was designed to investigate the oesophageal seal of the novel supralaryngeal airway device, I-Gel™ (I-Gel), in comparison with two of the laryngeal mask airways, Classic™ (cLMA) and ProSeal™ (pLMA), in a model of elevated oesophageal pressure. MethodsThe three supralaryngeal airway devices were inserted into eight unfixed cadaver models with exposed oesophagi that had been connected to a water column producing both a slow and a fast oesophageal pressure increase. The pressure applied until the loss of oesophageal seal during a slow and fast pressure increase was measured. ResultsDuring the slow increase of pressure, the pLMA withstood an oesophageal pressure up to a median of 58 cm H2O, while the cLMA was able to block the oesophagus up to a median of 37 cm H2O, and I-Gel already lost its seal at 13 cm H2O. One minute after maximum pressure had been applied, the pLMA withstood an oesophageal pressure of 59 cm H2O, the cLMA of 46 cm H2O, and I-Gel airway of 21 cm H2O. A fast release of oesophageal fluid was accomplished through the oesophageal lumen of both the pLMA and I-Gel. ConclusionsBoth the pLMA and cLMA provided a better seal of the oesophagus than the novel I-Gel airway. The pLMA and I-Gel drain off gastrointestinal fluid fast through the oesophageal lumen. Thus, tracheal aspiration may be prevented with their use. Further study is necessary.

Esophageal injuries: Spectrum of multidetector row CT findings

Background Aim of this study is to illustrate the multidetector row computed tomographic findings related to oesophageal injuries and their significance for therapeutic decisions. Method From April 2002 to April 2005 we studied 16 patients with suspected oesophageal injury. Ten patients underwent standard chest radiograph, while five patients with suspected foreign body ingestion were submitted to cervical plain film and gastrografin swallow study. All 16 patients underwent multidetector row CT examination. Results In six patients with cervical, thoracic and abdominal trauma, CT showed the presence of thoracic traumatic lesions and findings suggestive of perforation of the oesophagus. In five patients with foreign body ingestion cervical radiography was positive in only one case, while CT showed the presence of a foreign body in all cases. In three patients with post-intubation complications, CT showed the presence of perioesophageal fluid collection containing small gas bubbles in two cases and an oesophageal-aortic fistula in one case. In the remaining two patients with suspected spontaneous oesophageal perforation, CT demonstrated an oesophageal wall oedema and thickening in one case, and oesophageal fluid distension with perioesophageal small bubbles gas and fluid in the second case. Conclusion Oesophageal injuries, when complicated with perforation, constitute a life-threatening condition. Knowledge of the CT signs of oesophageal injuries has important implications for the role of imaging at the time of initial diagnosis.

SINGLE UMBILICAL ARTERY – AN INDICATOR OF ESOPHAGEAL ATRESIA?

Problemstellung: Esophageal atresia (ET) is a malformation, which is difficult to diagnose at prenatal screening, especially in the 2nd trimester of pregnancy. Indicators of ET are an empty or almost empty fetal stomach and polyhydramnios. Visualization of the esophageal fluid filled pouch at the level of ET has been described in recent years, but screening for ET by this sign is not applicable in routine sreening.

What Can Go Wrong, Will Go Wrong: A Look at Iatrogenia in the Abdomen and Pelvis

Advancements in both surgical and less invasive techniques have improved our ability to safely screen, diagnose, and treat disease within the abdomen and pelvis. Endoscopy, endoscopic retrograde cholangiopancreatography, interventional radiology, and laparoscopy have revolutionized the art of diagnosis and treatment of gastrointestinal tract disorders over the past 30 years. Key advances include direct inspection of bowel lumen, biopsy of suspected disorders, and treatment of abnormalities, including removal of mucosal lesions, dilatation, and stent placement of strictures. Radiologists must be aware of the complications resulting from a variety of gastrointestinal, radiologic, and surgical procedures. This article reviews the imaging findings related to incorrectly placed stents, intestinal and esophageal perforations, misplaced instruments, and fluid collections secondary to interventional procedures.

Ovine fetal swallowing: expression of preterm neurobehavioral rhythms.

Fetal swallowing contributes importantly to amniotic fluid volume regulation and fetal gastrointestinal maturation. Near-term ovine fetal swallowing occurs in discrete bouts of activity (at approximately 30-min intervals) in association with fetal electrocortical voltage changes. Thus, swallowing rhythms have been hypothesized to be entrained to fetal neurobehavioral states. In the preterm ovine fetus, electrocortical activity does not demonstrate differentiation into high- and low-voltage periods until 120-130 days' gestation. We sought to quantify patterns of preterm (114 days, 0.75 gestation) ovine fetal swallowing activity and volume, and, in view of the lack of electrocortical pattern changes, to explore whether swallowing activity was regulated by an independent central pacemaker. Six singleton ovine pregnancies were chronically prepared with fetal and maternal femoral artery and vein catheters. Biparietal electrocortical electrodes were placed on the fetal skull. Following a minimum 5-day recovery period, fetuses were studied at 114 +/- 1 days. Patterns of fetal swallowing behavior were quantified by computer analysis of laryngeal-esophageal electromyography (EMG) and thoracic esophageal fluid flow during a 12-h period. Esophageal fluid flow was bidirectional, although antegrade flow predominated, leading to an average fluid acquisition rate of 13 +/- 3 ml/h (7.3 +/- 1.8 ml/h per kg) during the 12-h study (302 +/- 87 ml/day). Propagated esophageal EMG activity, representing coordinated 'swallows', averaged 56 +/- 6 swallows/h and correlated well with net esophageal fluid flow. 'Bouts' of swallowing activity (> or = 3 swallows/min) averaged 9 +/- 1 swallows/bout, lasted 1.8 +/- 1.4 min and accounted for 31 +/- 4% of the swallowed volume. Despite the absence of fetal electrocortical high-voltage/low-voltage transitions, there was a 26.1 +/- 3.9-min interval between periods of swallowing bout activity. Preterm (0.75 gestation) ovine fetal volume swallowed (302 ml/day) and volume swallowed for body weight (175 ml/day per kg) was significantly less than that previously noted at 0.85 gestation (831 ml/day, 274 ml/day per kg, respectively; p < 0.05) although the rates of swallowing activity were similar. The presence of swallowing bout activity at periodic intervals, in the absence of electrocortical differentiation, suggests an intrinsic central pacemaker regulating preterm fetal neurobehavior.

Ovine fetal swallowing: expression of preterm neurobehavioral rhythms

Objective: Fetal swallowing contributes importantly to amniotic fluid volume regulation and fetal gastrointestinal maturation. Near-term ovine fetal swallowing occurs in discrete bouts of activity (at approximately 30-min intervals) in association with fetal electrocortical voltage changes. Thus, swallowing rhythms have been hypothesized to be entrained to fetal neurobehavioral states. In the preterm ovine fetus, electrocortical activity does not demonstrate differentiation into high- and low-voltage periods until 120-130 days' gestation. We sought to quantify patterns of preterm (114 days, 0.75 gestation) ovine fetal swallowing activity and volume, and, in view of the lack of electrocortical pattern changes, to explore whether swallowing activity was regulated by an independent central pacemaker. Methods: Six singleton ovine pregnancies were chronically prepared with fetal and maternal femoral artery and vein catheters. Biparietal electrocortical electrodes were placed on the fetal skull. Following a minimum 5-day recovery period, fetuses were studied at 114 &#45 1 days. Patterns of fetal swallowing behavior were quantified by computer analysis of laryngeal-esophageal electromyography (EMG) and thoracic esophageal fluid flow during a 12-h period. Results: Esophageal fluid flow was bidirectional, although antegrade flow predominated, leading to an average fluid acquisition rate of 13 &#45 3 ml/h (7.3 &#45 1.8 ml/h per kg) during the 12-h study (302 &#45 87 ml/day). Propagated esophageal EMG activity, representing coordinated 'swallows', averaged 56 &#45 6 swallows/h and correlated well with net esophageal fluid flow. 'Bouts' of swallowing activity ( &#83 3 swallows/min) averaged 9 &#45 1 swallows/bout, lasted 1.8 &#45 1.4 min and accounted for 31 &#45 4% of the swallowed volume. Despite the absence of fetal electrocortical high-voltage/ low-voltage transitions, there was a 26.1 &#45 3.9-min interval between periods of swallowing bout activity. Conclusions: Preterm (0.75 gestation) ovine fetal volume swallowed (302 ml/day) and volume swallowed for body weight (175 ml/day per kg) was significantly less than that previously noted at 0.85 gestation (831 ml/day, 274 ml/day per kg, respectively; p < 0.05) although the rates of swallowing activity were similar. The presence of swallowing bout activity at periodic intervals, in the absence of electrocortical differentiation, suggests an intrinsic central pacemaker regulating preterm fetal neurobehavior.

3465 The durability of different solutions injected submucosally in a porcine model.

During endoscopic mucosal resection and polypectomy of sessile lesions an injected submucosal fluid cushion isolates the tissue prior to resection and reduces thermal injury, perforation, and hemorrhage. Aim: To investigate the efficacy of five different solutions in creating a durable submucosal esophageal fluid cushion in a pig model. Methods: Five groups of 5 pigs were studied. In each pig, six submucosal injections of 5 cc of a test solution were performed within the lower third of the esophagus. The time required for the elevated mucosa to flatten completely was recorded after each injection. The solutions used were: normal saline (NS), NS+epinephrine (NSE), dextrose 50% (D50), 10% glycerine/5% fructose in NS (G), and 1% rooster comb hyaluronic acid (HA). Statistical analysis was performed using analysis of variance (ANOVA). NS was used as the standard solution for comparative analysis. Results: The mean and median times (minutes) for each solution to dissipate are provided in the table below. Conclusions: 1. This study provides important and practical information on the durability of available solutions used to create a submucosal fluid cushion during endoscopic mucosal resection and polyectomy of sessile lesions. 2. Hyaluronic acid appears to be the ideal solution for a lasting submucosal cushion during prolonged procedures. 3. Dextrose 50% is superior to normal saline and serves as a practical alternative in terms of availabilty and cost.

Locations and molecular forms of gastrin-releasing peptide-like immunoreactive entities in ovine pregnancy.

Large quantities of gastrin-releasing peptide-like immunoreactivity (GRP-LI) are present in ovine pregnancy fluids (allantoic fluid > fetal plasma > esophageal fluid = amniotic fluid = urine > maternal plasma) and in term endometrium (60 +/- 29 pmol.g-1) and myometrium (4.5 +/- 1.2 pmol.g-1). The larger molecular size [greater than GRP (1-27)] of this GRP-LI entity is not due to a GRP binding protein nor to a C-terminal extension of GRP. In contrast, ovine fetal colon extracts appear to contain the usual GRP (1-27) and GRP (18-27) forms. Hence, the uterus, not the fetus, is the probable source of this novel GRP-like peptide. It apparently acts as a hormone in ovine pregnancy and may play an important role in fetal-placental development.