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Endoscopic augmentation of the esophagogastric junction with polymethylmethacrylate: durability, safety, and efficacy after 6 months in mini-pigs

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Abstract

Background and aims

Endoscopic augmentation of the esophagogastric junction (EGJ) with polymethylmethacrylate (PMMA) has been reported in an experimental short-term study. We assessed whether endoscopic augmentation of the EGJ with PMMA is durable, safe, and efficacious after 6 months in mini-pigs.

Methods

Ten mini-pigs were studied under anesthesia. After a pilot study in two animals, eight mini-pigs underwent lower esophageal sphincter (LES) manometry and gastrostomy with measurement of gastric yield volume (GYV) and gastric yield pressure (GYP). Endoscopic implantation of PMMA was performed aiming for the submucosa of the EGJ. Six months later, LES manometry and GYV and GYP measurements were repeated and animals were sacrificed, followed by microscopic analyses of the EGJ.

Results

Out of 32 implants (four per animal), 29 (91%) were identified as submucosal nodules postmortem. PMMA deposits were found at microscopic analysis in all animals and located as follows [mean (range)]: submucosa 61.5% (37.5–91%), muscularis propria 21.5% (0–58%), mucosa 11% (0–25%), and subserosa 6% (0–17%). Neither esophageal perforation nor death was observed. A significant increase in GYV (1,404 versus 905 ml; p = 0.02) and a borderline increase in GYP (8.1 versus 6.5 mmHg; p = 0.057) were detected 6 months later.

Conclusions

Endoscopic augmentation of the esophagogastric junction with PMMA was durable and had no complications after 6 months. However, the occurrence of implants in the subserosa requires technical refinement before use in clinical trials.

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Abbreviations

PMMA:

Polymethylmethacrylate

EGJ:

Esophagogastric junction

GERD:

Gastroesophageal reflux disease

LES:

Lower esophageal sphincter

GYV:

Gastric yield volume

GYP:

Gastric yield pressure

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Acknowledgements

Study supported by CAPES (Ministry of Education and Culture), CNPq (Conselho Nacional de Desenvolvimento Científico e Tecnológico—Ministry of Science and Technology), and FIPE (Hospital de Clínicas de Porto Alegre), Brazil.

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Authors and Affiliations

  1. Post-Graduation Program: Sciences in Gastroenterology, School of Medicine, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, 2º andar, Bairro Santana, Porto Alegre, RS, Brazil

    Fernando Fornari, Carmen P. F. Freitag, Marcos E. S. Duarte & Sérgio G. S. Barros

  2. School of Medicine, Universidade de Passo Fundo, Passo Fundo , RS, Brazil

    Fernando Fornari

  3. Service of Gastroenterology, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil

    Sérgio G. S. Barros

  4. Service of General Surgery, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil

    Cleber R. P. Kruel

  5. Service of Pathology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil

    Luise Meurer & Carlos T. Z. Cerski

  6. Bioengineering Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil

    Paulo R. O. Thomé & Paulo R. S. Sanches

  7. Laboratory of Experimental Motility, Animal Experimental Unit, Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil

    Fernando Fornari, Carmen P. F. Freitag, Marcos E. S. Duarte, Cleber R. P. Kruel & Sérgio G. S. Barros

  8. Chemistry Institute, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil

    Cesar Liberato Petzhold

  9. Department of Statistics, Post-Graduation Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil

    Sidia M. Callegari-Jacques

Authors
  1. Fernando Fornari
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  2. Carmen P. F. Freitag
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  3. Marcos E. S. Duarte
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  4. Cleber R. P. Kruel
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  5. Paulo R. O. Thomé
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  6. Paulo R. S. Sanches
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  7. Luise Meurer
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  8. Carlos T. Z. Cerski
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  9. Cesar Liberato Petzhold
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  10. Sidia M. Callegari-Jacques
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  11. Sérgio G. S. Barros
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Corresponding author

Correspondence to Fernando Fornari.

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Fornari, F., Freitag, C.P.F., Duarte, M.E.S. et al. Endoscopic augmentation of the esophagogastric junction with polymethylmethacrylate: durability, safety, and efficacy after 6 months in mini-pigs. Surg Endosc 23, 2430–2437 (2009). https://doi.org/10.1007/s00464-009-0376-8

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  • DOI: https://doi.org/10.1007/s00464-009-0376-8

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