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A potential simple endoscopic antireflux method, "the Ripple Procedure" to reduce distensibility at the esophagogastric junction in a porcine model.

Abstract

BACKGROUND AND AIMS

Currently available endoscopic or minimally invasive antireflux modalities are not widely accepted due to high procedure cost or inconsistent results. Therefore, a simpler and less technically demanding method is required. We evaluated the feasibility and efficacy of new endoscopic antireflux method (the Ripple Procedure) using functional lumen imaging probe (FLIP).

METHODS

This 5-week survival study included 10 domestic pigs (control, n = 4; experimental [Ripple], n = 6). The procedure includes the following steps: (i) semicircular marking along the lesser curvature of the cardia; (ii) submucosal injection; and (iii) semicircular mucosal incision along the marking. Endoscopic and FLIP evaluations were performed preoperatively and on postoperative days (PODs) 14 and 35. Technical feasibility was evaluated, and FLIP parameters, including the distensibility index (DI) at the esophagogastric junction (EGJ) and histopathological findings, were compared between groups.

RESULTS

The median procedure time was 28 (23.5-33.8) min. There was no significant difference in dysphagia score and body weight between groups. On POD 35, the Ripple group showed significantly lower EGJ DI at 30 mL [2.0 (1.3-2.5) vs 4.9 (2.7-5.0), P = 0.037]. The EGJ DI was significantly reduced at 30 mL, compared with that at the baseline level [- 59.0% (- 68.8% to - 32.1%) vs 27.8% (- 26.3% to 83.1%), P = 0.033]. Histologic evaluation revealed submucosal granulation tissues near the mucosal incision site, with increased intervening fibrosis between lower esophageal sphincter fibers in the Ripple group.

CONCLUSION

The EGJ DI significantly decreased after the Ripple Procedure; hence, the procedure appears to be feasible and effective in this porcine model.

Authors+Show Affiliations

Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.Department of Pathology, Yonsei University College of Medicine, Seoul, Korea.Division of Gastroenterology, Department of Internal Medicine, Institute of Gastroenterology, , Severance Hospital, Yonsei University College of Medicine, 50-Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea. kaarma@yuhs.ac.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31820155

Citation

Chung, Hyunsoo, et al. "A Potential Simple Endoscopic Antireflux Method, "the Ripple Procedure" to Reduce Distensibility at the Esophagogastric Junction in a Porcine Model." Surgical Endoscopy, 2019.
Chung H, Kim SH, Shin SK. A potential simple endoscopic antireflux method, "the Ripple Procedure" to reduce distensibility at the esophagogastric junction in a porcine model. Surg Endosc. 2019.
Chung, H., Kim, S. H., & Shin, S. K. (2019). A potential simple endoscopic antireflux method, "the Ripple Procedure" to reduce distensibility at the esophagogastric junction in a porcine model. Surgical Endoscopy, doi:10.1007/s00464-019-07296-7.
Chung H, Kim SH, Shin SK. A Potential Simple Endoscopic Antireflux Method, "the Ripple Procedure" to Reduce Distensibility at the Esophagogastric Junction in a Porcine Model. Surg Endosc. 2019 Dec 9; PubMed PMID: 31820155.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A potential simple endoscopic antireflux method, "the Ripple Procedure" to reduce distensibility at the esophagogastric junction in a porcine model. AU - Chung,Hyunsoo, AU - Kim,Se Hoon, AU - Shin,Sung Kwan, Y1 - 2019/12/09/ PY - 2019/07/03/received PY - 2019/11/28/accepted PY - 2019/12/11/entrez PY - 2019/12/11/pubmed PY - 2019/12/11/medline KW - Antireflux treatment KW - Distensibility index KW - Esophagogastric junction JF - Surgical endoscopy JO - Surg Endosc N2 - BACKGROUND AND AIMS: Currently available endoscopic or minimally invasive antireflux modalities are not widely accepted due to high procedure cost or inconsistent results. Therefore, a simpler and less technically demanding method is required. We evaluated the feasibility and efficacy of new endoscopic antireflux method (the Ripple Procedure) using functional lumen imaging probe (FLIP). METHODS: This 5-week survival study included 10 domestic pigs (control, n = 4; experimental [Ripple], n = 6). The procedure includes the following steps: (i) semicircular marking along the lesser curvature of the cardia; (ii) submucosal injection; and (iii) semicircular mucosal incision along the marking. Endoscopic and FLIP evaluations were performed preoperatively and on postoperative days (PODs) 14 and 35. Technical feasibility was evaluated, and FLIP parameters, including the distensibility index (DI) at the esophagogastric junction (EGJ) and histopathological findings, were compared between groups. RESULTS: The median procedure time was 28 (23.5-33.8) min. There was no significant difference in dysphagia score and body weight between groups. On POD 35, the Ripple group showed significantly lower EGJ DI at 30 mL [2.0 (1.3-2.5) vs 4.9 (2.7-5.0), P = 0.037]. The EGJ DI was significantly reduced at 30 mL, compared with that at the baseline level [- 59.0% (- 68.8% to - 32.1%) vs 27.8% (- 26.3% to 83.1%), P = 0.033]. Histologic evaluation revealed submucosal granulation tissues near the mucosal incision site, with increased intervening fibrosis between lower esophageal sphincter fibers in the Ripple group. CONCLUSION: The EGJ DI significantly decreased after the Ripple Procedure; hence, the procedure appears to be feasible and effective in this porcine model. SN - 1432-2218 UR - https://www.unboundmedicine.com/medline/citation/31820155/A_potential_simple_endoscopic_antireflux_method,_"the_Ripple_Procedure"_to_reduce_distensibility_at_the_esophagogastric_junction_in_a_porcine_model L2 - https://dx.doi.org/10.1007/s00464-019-07296-7 DB - PRIME DP - Unbound Medicine ER -