| Gastric transmural pressure measurements in vivo: implications for natural orifice transluminal endoscopic surgery (NOTES). | |
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MedLine Citation:
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PMID: 20189518 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: The success of natural orifice surgery depends on a reliable, secure closure of the opening in the gut. Forces that might be exerted on the gastric wall to disrupt closure have not been measured in humans or animals. OBJECTIVE: To determine how transmural gastric pressure gradients vary under different experimental conditions. DESIGN: In vivo porcine model. SETTING: Animal laboratory. PATIENTS: Eleven laboratory pigs. INTERVENTIONS: Pressure transducers were placed in the abdomen and stomachs of the test animals. Simultaneous pressure measurements were obtained to determine the stresses applied to the gastric wall during various maneuvers. MAIN OUTCOME MEASUREMENTS: Continuous intra-abdominal and intragastric pressures in vivo. Transgastric pressure gradients (DeltaP) were computed in real time by subtracting gastric pressure from abdominal pressure. RESULTS: In all cases, the measured gastric pressures were nearly identical to those measured in the abdominal cavity because the stomach is entirely contained within the abdomen. The transmural gastric pressure gradients were near zero during a variety of experimental conditions. LIMITATION: Anesthetized animal model, not engaged in usual activities. Relatively low pressures generated during a cough sequence and a Valsalva maneuver compared with reported values in the literature. CONCLUSION: Estimates of gastric pressures that must be tolerated by gastric closure devices after natural orifice transluminal endoscopic surgery procedures have been greatly overestimated. Absolute gastric pressure is counteracted by external (intra-abdominal) pressure such that the net transmural gastric pressure gradient remains near zero under a variety of conditions. |
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Authors:
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David J Desilets; Timothy J Mader; John R Romanelli; David B Earle |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Gastrointestinal endoscopy Volume: 71 ISSN: 1097-6779 ISO Abbreviation: Gastrointest. Endosc. Publication Date: 2010 Mar |
Date Detail:
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Created Date: 2010-03-01 Completed Date: 2010-05-27 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0010505 Medline TA: Gastrointest Endosc Country: United States |
Other Details:
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Languages: eng Pagination: 583-8 Citation Subset: IM |
Copyright Information:
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2010 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved. |
Affiliation:
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Division of Gastroenterology, Department of Medicine, Tufts University School of Medicine, Baystate Medical Center, Springfield, Massachusetts 01199, USA. david.desilets@bhs.org |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Abdominal Wall
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physiopathology Animals Endoscopy, Gastrointestinal / methods* Pressure Stomach / surgery* Swine Transducers |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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