Abstract
Background
Endoscopic methods to prevent gastroesophageal reflux (GER) show scarce effectiveness and may narrow the esophageal lumen more or less stiffly, sometimes impairing bolus transit and leading to dysphagia. The aim of this study was to demonstrate the possibility of reinforcing lower esophageal sphincter (LES) tone by implanting endoluminally a magnetic device.
Materials and methods
The device consists of two small magnetic plaques to be implanted in the submucosa close to LES with opposite polarities facing so that they attract one other, closing the esophageal lumen. The magnets were implanted by means of a special endoluminal device in five esophageal-gastric ex vivo specimens taken from swine. Variation in endoluminal pressure at the LES level was measured by means of slow pull-through of a thin side-hole manometric catheter in each specimen, before and after insertion of the magnets.
Results
The new high-pressure zone exhibited a length of about 2 cm and a pressure of 14.2 ± 1.27 mmHg [mean ± standard deviation (SD)], significantly (p < 0.001) higher than that measured before insertion of the magnetic valve (1.5 ± 0.26 mmHg).
Conclusions
The present research demonstrates that it is possible to create at the LES level a dynamic closure of a value considered sufficient to prevent GER, by implanting in the esophageal submucosa of anatomical specimens a magnetic device by means of a special endoluminal probe. Once effectiveness and tolerability of magnets covered by a biocompatible sheath have been demonstrated in vivo, this device could become a simple and effective nonsurgical solution to GER.
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References
Wakelin DE, Sampliner RE (2005) Endoscopic antireflux procedures: a good wrap? Clin Gastro Hepatol 3:831
Hogan WJ (2006) Clinical trials evaluating endoscopic GERD treatments is it time for a moratorium on the clinical use of these procedures? Am J Gastroenterol 101:437–439
Shaheen NJ (2006) The rise and fall (and rise?) of endoscopic anti-reflux procedures. Gastroenterology 131:952–962
Rothstein RI (2008) Endoscopic therapy of gastroesophageal reflux disease: outcomes of the randomized-controlled trials done to date. J Clin Gastroenterol 45:594–602
Bortolotti M (2006) A novel antireflux device based on magnets. J Biomech 39:564–567
Dodds WJ, Dent J, Hogan WJ, Helm JF, Hauser R, Patel GK, Egide MS (1982) Mechanisms of gastroesophageal reflux in patients with reflux esophagitis. N Engl J Med 307:1547–1552
Fein M, Ritter MP, De Meester TR, Oberg S, Peters JH, Hagen JA, Bremner CG (1999) Role of the lower esophageal sphincter and hiatal hernia in the pathogenesis of gastroesophageal disease. J Gastrointest Surg 4:405–411
Ismail T, Bancewicz J, Barlow J (1995) Yield pressure, anatomy of the cardia and gastro-esophageal reflux. Br J Surg 82:943–947
Richter JE, Wu WC, Johns DN, Blackwell JN, Nelson JL III, Castell JA, Castell DO (1987) Esophageal manometry in 95 healty adult volunteers. Dig Dis Sci 32:583–592
Kahrilas PJ, Dodds WJ, Hogan WJ, Kern M, Arndorfer RC, Reece A (1986) Esophageal peristaltic dysfunction in peptic esophagitis. Gastroenterology 91:897–904
Jansen A, Becker AE, Brummelkamp WH, Davies GAG, Klopper PJ, Keeman JN (1981) Clinical applications of magnetic rings in colorectal anastomosis. Surg Gynec Obstet 153:537–545
Chopita N, Vaillaverde A, Cope C, Bernedo A, Martinez H, Landoni N, Jmelnitzky A, Burgos H (2005) Endoscopic gastroenteric anastomosis using magnets. Endoscopy 37:313–317
Guyton AC, Hall JE (1966) Textbook of medical physiology. WB Saunders Co, Philadelphia, PA
Acknowledgments
We thank the GAUSS Magneti s.r.l. company of Fornaci (BS) for furnished the magnets for free.
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This study was accepted for poster presentation to the Digestive Disease Week held in Washington, May 19–24, 2007, and published as an abstract in Gastroenterology 2007;132:A494.
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Bortolotti, M., Grandis, A. & Mazzero, G. A novel endoesophageal magnetic device to prevent gastroesophageal reflux. Surg Endosc 23, 885–889 (2009). https://doi.org/10.1007/s00464-008-0244-y
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DOI: https://doi.org/10.1007/s00464-008-0244-y