Developmental Endoscopy Unit, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Surg Endosc. 2012 Jun;26(6):1751-8. doi: 10.1007/s00464-011-2105-3. Epub 2012 Jan 19.
Esophageal myotomy using submucosal endoscopy with mucosal safety flap (SEMF) has been proposed as a new treatment of achalasia. In this technique, a partial-thickness myotomy (PTM) preserving the longitudinal outer esophageal muscular layer is advocated, which is different from the usual full-thickness myotomy (FTM) performed surgically. The aim of this study was to compare endoscopic FTM and PTM and analyze the outcomes of each method after a 4 week survival period.
Twenty-four pigs were randomly assigned into group A (FTM, 12 animals) and group B (PTM) to undergo endoscopic myotomy. Lower esophageal sphincter (LES) pressure was assessed using pull-through manometry. For statistical analysis we compared the average esophageal sphincter pressure values at baseline, after 2 weeks, and after 4 weeks between groups A and B. The P value was set as <0.05 for significance.
Eighteen animals were included for statistical analysis. Mean (SD) LES pressures were similar between groups A and B (nine animals each) at baseline [group A = 23 (10.4) mmHg; group B = 20.7 (8.7) mmHg; P = 0.79], after 2 weeks [group A = 19 (7.7) mmHg; group B = 21.8 (8.4) mmHg; P = 0.79], and after 4 weeks [group A = 22.6 (10.2) mmHg; group B = 20.7 (9) mmHg; P = 0.82]. LES pressures were significantly reduced in three animals after 4 weeks: one animal (1%) in group A and two animals (2.5%) in group B. An extended myotomy (3 cm below the cardia) was achieved in three animals and was responsible for the significant drop in LES pressure seen in the two animals from group B.
Esophageal myotomy using SEMF is a feasible yet challenging procedure in pigs. Full-thickness myotomy does not seem to be superior to partial-thickness myotomy as demonstrated by pull-through manometry. Endoscopic esophageal myotomy results are greatly influenced by obtaining adequate myotomy extension into the gastric cardia.
黏膜下内镜下食管肌切开术（SEMF）联合黏膜安全瓣被提议作为贲门失弛缓症的一种新的治疗方法。在该技术中，提倡进行保留食管外纵行肌层的部分厚度肌切开术（PTM），这与手术中常用的全厚度肌切开术（FTM）不同。本研究的目的是比较内镜 FTM 和 PTM，并分析每种方法在 4 周的生存期间的结果。
24 头猪被随机分为 A 组（FTM，12 头）和 B 组（PTM），进行内镜肌切开术。通过经食管测压法评估食管下括约肌（LES）压力。为了进行统计学分析，我们比较了 A 组和 B 组在基线、2 周后和 4 周后的平均食管括约肌压力值。显著性差异的 P 值设定为<0.05。
18 头动物纳入统计学分析。A 组和 B 组（每组 9 头）的 LES 压力在基线时相似[A 组=23（10.4）mmHg；B 组=20.7（8.7）mmHg；P=0.79]，2 周后[A 组=19（7.7）mmHg；B 组=21.8（8.4）mmHg；P=0.79]，4 周后[A 组=22.6（10.2）mmHg；B 组=20.7（9）mmHg；P=0.82]。4 周后，3 头动物的 LES 压力显著下降：A 组 1 头（1%），B 组 2 头（2.5%）。3 头动物进行了扩展肌切开术（距离贲门 3 cm 以下），这导致了 B 组 2 头动物的 LES 压力显著下降。
SEMF 内镜下食管肌切开术在猪中是一种可行但具有挑战性的方法。经食管测压法显示，全厚度肌切开术并不优于部分厚度肌切开术。内镜下食管肌切开术的结果受获得足够的胃贲门延伸肌切开术的影响很大。
