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Published in:

01-06-2009

Endoscopic implantation of polymethylmethacrylate augments the gastroesophageal antireflux barrier: a short-term study in a porcine model

Authors: C. P. F. Freitag, C. R. P. Kruel, M. E. S. Duarte, P. R. E. Sanches, P. R. O. Thomé, F. Fornari, D. Driemeier, F. Teixeira, R. O. Mollerke, S. M. Callegari-Jacques, S. G. S. Barros

Published in: Surgical Endoscopy | Issue 6/2009

Abstract

Background and aims

Endoscopic injection of filler agents into the esophagogastric junction has been developed to augment the antireflux barrier and decrease gastroesophageal reflux (GER). However, evidence of efficacy is lacking and serious complications have been reported in humans. The aim of this study was to assess whether endoscopic implantation of polymethylmethacrylate augments the antireflux barrier in a porcine model for GER.

Methods

Large White pigs underwent esophageal manometry, gastric yield pressure (GYP), and gastric yield volume (GYV) measurements and implantation of PMMA in the distal esophagus under general anesthesia. After follow-up of 28 days, esophageal manometry and gastric yield measurements were repeated and animals sacrificed.

Results

Implantation of PMMA was performed in 18 animals, and 14 animals survived 28 days. There was a significant increase in GYP (10.7 mmHg versus 8.1 mmHg; p = 0.017) and GYV (997 ml versus 393 ml; p < 0.001) after PMMA implantation, whereas resting LES pressure did not change significantly. Acute inflammatory changes and fibrous tissue deposits were found surrounding the PMMA implants during histology. One animal died after esophageal perforation and three others due to pneumonia (two) and colon perforation (one) in the postoperative period.

Conclusions

Endoscopic implantation of PMMA in the distal esophagus augments the antireflux barrier 28 days after the procedure. However, esophageal perforation points to the need for technical refinements to make the procedure safer.

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Title: Endoscopic implantation of polymethylmethacrylate augments the gastroesophageal antireflux barrier: a short-term study in a porcine model
Authors: C. P. F. Freitag
C. R. P. Kruel
M. E. S. Duarte
P. R. E. Sanches
P. R. O. Thomé
F. Fornari
D. Driemeier
F. Teixeira
R. O. Mollerke
S. M. Callegari-Jacques
S. G. S. Barros
Publication date: 01-06-2009
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 6/2009
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-008-0145-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Endoscopic implantation of polymethylmethacrylate augments the gastroesophageal antireflux barrier: a short-term study in a porcine model

Abstract

Background and aims

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background and aims

Methods

Results

Conclusions

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