Department of Surgery, Odense University Hospital, Odense, Syddanmark, Denmark.
Department of Surgery, University of Vermont Larner College of Medicine, Burlington, Vermont, United States.
Eur J Pediatr Surg. 2022 Oct;32(5):460-464. doi: 10.1055/s-0042-1745783. Epub 2022 Jun 10.
Treatment for long-gap esophageal atresia (LGEA) aims at achieving primary anastomosis with minimal tension. Previous studies have shown that intramural injections with botulinum toxin type-A (BTX-A) from the adventitial side can increase the elongation of the piglet and rat esophagus before bursting, and that this effect is dose and time dependent. Our aim was to determine if endoscopic injections would be feasible, safe, and with an effect on the mechanical properties of the esophagus.
Twenty-two male piglets (5.15 kg) were randomized into two groups, one receiving 2 units/kg BTX-A, the other equal volume 0.9% NaCl. On day 3, the esophagus was harvested and tested in a stretch-tension machine to evaluate elongation and maximum load, followed by histological examination.
No adverse effects to the procedure were observed. No statistically significant difference in elongation or maximum load before bursting between the treatment and placebo group was found. In histopathological analysis, inflammation and abscess formation were observed with no statistically significant difference between the two groups.
Endoscopic placement of BTX-A injections in the piglet esophagus was safe and feasible but did not result in any difference in the mechanical properties or histology of the esophagus.
治疗长段食管闭锁（LGEA）的目的是实现最小张力的一期吻合。先前的研究表明，从 adventitial 侧注射肉毒杆菌毒素 A（BTX-A）可以增加小猪和大鼠食管在破裂前的伸长，并且这种效果与剂量和时间有关。我们的目的是确定内镜注射是否可行、安全，并对食管的机械性能有影响。
22 只雄性小猪（5.15kg）随机分为两组，一组接受 2 单位/kg BTX-A，另一组接受等体积 0.9%生理盐水。第 3 天，取出食管并在拉伸-张力机上进行测试，以评估伸长率和最大负荷，然后进行组织学检查。
未观察到该操作的不良影响。治疗组和安慰剂组在破裂前的伸长率或最大负荷方面无统计学差异。在组织病理学分析中，两组均观察到炎症和脓肿形成，但无统计学差异。
在小猪食管中进行内镜下 BTX-A 注射是安全可行的，但不会导致食管的机械性能或组织学发生任何变化。
