Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave, Evanston, IL, 60201, USA.
Department of Surgery, University of Chicago, Chicago, USA.
J Gastrointest Surg. 2023 Aug;27(8):1531-1538. doi: 10.1007/s11605-021-05205-9. Epub 2023 Apr 13.
Endoscopic sleeve gastroplasty is an example of endoscopic sutured plications being used to remodel a gastrointestinal organ. With per-oral plication of the esophagus (POPE), similar plications are used to remodel the dilated and redundant megaesophagus of end-stage achalasia. Redundancies and dilations can also develop in the neoesophagus of a patient with prior esophagectomy. Megaesophagus and a redundant neoesophagus can both lead to debilitating dysphagia, regurgitation, and recurrent aspiration pneumonia. Traditionally, this anatomic problem requires complex revisional or excisional surgery, to which POPE offers an incisionless alternative.
This is a dynamic manuscript with video demonstration of POPE, as well as review of five cases performed in 1 year. Data were collected in a prospectively maintained database, and the institutional review board approved retrospective review for this publication. The procedure is performed using a dual-channel upper endoscope fixed with an endoscopic suturing device, with the patient supine under general anesthesia.
POPE was technically completed in all cases with no serious complications, and patients either went home the same day or spent one night for observation. Most patients reported immediate and substantial symptomatic improvement. Objective pre- and post-measures include esophagram and nuclear gastric emptying studies.
This article discusses early experience at one institution with POPE, with detailed description of the procedure and technical considerations. An accompanying video reviews two cases, one with megaesophagus and one with a gastric conduit. While this novel procedure has limited and rare indications, it offers a low-morbidity solution to a challenging anatomic problem that traditionally requires invasive surgery.
内镜袖状胃成形术是一种使用内镜缝合技术来重塑胃肠道器官的范例。经口食管折叠术（POPE）采用类似的折叠技术来重塑终末期贲门失弛缓症的扩张和冗余巨食管。食管切除术的患者新食管也可能出现冗余和扩张。巨食管和冗余新食管均可导致严重的吞咽困难、反流和反复吸入性肺炎。传统上，这种解剖问题需要复杂的修正或切除手术，而 POPE 则提供了一种无切口的替代方案。
这是一份动态手稿，其中包括 POPE 的视频演示，以及对 1 年内进行的 5 例病例的回顾。数据是在一个前瞻性维护的数据库中收集的，机构审查委员会批准了本出版物的回顾性审查。该手术使用带有内镜缝合装置的双通道上消化道内镜进行，患者全身麻醉下仰卧位。
所有病例均成功完成 POPE 技术，无严重并发症，患者当天或观察一晚后即可出院。大多数患者报告立即出现明显的症状改善。客观的术前和术后测量包括食管造影和核胃排空研究。
本文讨论了一家机构在 POPE 方面的早期经验，详细描述了该手术的过程和技术要点。一个配套视频回顾了两个病例，一个是巨食管，另一个是胃管。虽然这种新手术的适应证有限且罕见，但它为传统上需要侵入性手术的具有挑战性的解剖问题提供了一种低并发症的解决方案。
