Background and Aims

Endolumenal therapies serve as a treatment option for GERD. This study aimed to determine if magnets could be placed endoscopically using the adventitial layer to create a subadventitial space near the esophagogastric junction to augment the lower esophageal sphincter using submucosal endoscopy.

Methods

This study consisted of 2 phases, ex vivo and in vivo, with domestic pig esophagus. A long submucosal tunnel was made at the mid to lower esophagus. The muscularis propria was incised by a needle-knife within the submucosal tunnel. A subadventitial tunnel was made by biliary balloon catheter blunt dissection, and a magnet was deployed in the subadventitial space. The same maneuver was done within the opposing esophageal wall, with magnet placement in the opposing subadventitial space.

Results

Submucosal tunnels and subadventitial tunnels were successful without perforation ex vivo in all attempts and in 9 of 10 cases, respectively. Magnets were deployed in the subadventitial space in 7 cases. Magnets connected and separated with atraumatic endoscope passage into the stomach and reconnected when the endoscope was withdrawn under fluoroscopy in 5 of 7 cases (71.4%). In vivo submucosal tunnels and subadventitial tunnels were successful in all 5 cases, and magnet augmentation was functionally active in 4 cases (80%).

Conclusion

Subadventitial tunnels were feasible and could represent a new working space for endoscopic treatment. Endoscopic placement of magnets within the subadventitial space may be an attractive alternative endolumenal therapy for GERD.

中文翻译：

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内镜将磁体放置在胃外膜下隧道中，以使用粘膜下内窥镜增强食管下括约肌：在猪模型中的离体和体内研究（带视频）

背景和目标

内泌素疗法可作为GERD的治疗选择。这项研究的目的是确定是否可以使用外膜层在内窥镜下放置磁体，以在食管胃交界附近形成一个下膜外空间，以使用粘膜下内窥镜增强食管下括约肌。

方法

这项研究包括离体和体内两个阶段，分别与家养猪食道有关。在中下食管处形成了一条长的粘膜下隧道。用黏膜下隧道内的针刀切开固有肌层。胆囊球囊钝性解剖形成了一个膜下隧道，并在膜下腔中部署了一块磁铁。在相对的食管壁内进行相同的操作，将磁铁放置在相对的外膜下腔中。

结果

在所有尝试中，粘膜下隧道和胃外下隧道均成功地进行了体外穿刺而无穿孔，分别在10例中的9例中。在外膜下腔中部署了磁铁7例。在7例中有5例中，无创内窥镜通过胃镜将磁铁连接并分开，然后在荧光透视下将内窥镜抽出后重新连接。体内粘膜下隧道和外膜下隧道均在所有5例中均获得成功，并且在4例（80％）的患者中，磁体增强功能活跃。

结论

腹膜下隧道是可行的，并可能代表内窥镜治疗的新工作空间。内窥镜在外膜下腔内放置磁体可能是GERD的一种有吸引力的替代腔内治疗方法。