| Evaluation of endoscopic full-thickness plication on anti-reflux valve competency. | |
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MedLine Citation:
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PMID: 18439539 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: We sought to investigate the efficacy of endoscopically created, full-thickness plications on the competency of the anti-reflux barrier when placed at different positions on the stomach adjacent to the gastroesophageal junction. METHODS: Explanted human cadaver stomachs and esophagi were used. An endoscopic plication system (Plicator, NDO Surgical, Mansfield, Massachusetts) was then fitted over a pediatric gastroscope and passed through the esophagus into the stomach. A full-thickness plication implant was then deployed at 1 of 3 positions (fundus, anterior, and between the anterior and the lesser curvature) on the explanted stomach within 1 cm of the gastroesophageal junction. Intragastric pressure was measured before and after plication at the time of visible reflux from the esophagus (reflux threshold) using a water-perfused manometer. RESULTS: Five explanted stomachs were used. The mean reflux threshold before plication (baseline) was 1.7 mm Hg. A single plication at each position resulted universally in a significantly increased reflux threshold over the baseline value (p < 0.006). The greatest reflux threshold was observed when plication was performed on the anterior wall of the stomach, although this reflux pressure did not achieve statistical significance over the other 2 positions. A second plication performed adjacent to the initial plication at the fundus (n = 2) and anterior (n = 2) positions did increase reflux threshold; however, this increase also failed to achieve statistical significance. CONCLUSIONS: These results suggest that an endoscopic, full-thickness plication system can inhibit gastroesophageal reflux effectively in an explanted stomach model. Although anterior plication resulted in the greatest intragastric pressure at reflux, it was not significantly different from intragastric pressure recorded at the other plication positions. A second plication adjacent to the first showed incremental effect, but larger studies are warranted to understand its clinical significance. |
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Authors:
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James P Dolan; Douglas M Downey; Brett C Sheppard; M Brian Fennerty; John G Hunter |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Journal of surgical education Volume: 65 ISSN: 1931-7204 ISO Abbreviation: - Publication Date: 2008 Mar-Apr |
Date Detail:
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Created Date: 2008-04-28 Completed Date: 2008-09-04 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101303204 Medline TA: J Surg Educ Country: United States |
Other Details:
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Languages: eng Pagination: 140-4 Citation Subset: IM |
Affiliation:
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Division of General Surgery, Department of Surgery, and The Digestive Health Center, Oregon Health and Science University, Portland, OR, USA. james.dolan@keesler.af.mil |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Cadaver Esophagogastric Junction / surgery* Female Gastroesophageal Reflux / surgery* Gastroscopy / methods* Humans Male Middle Aged Suture Techniques* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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