A preclinical feasibility study of endoscopic barostat: A possible diagnostic tool for visceral hypersensitivity in functional dyspepsia

Introduction: Diagnosing functional dyspepsia requires excluding organic disease and gastrointestinal function evaluation; however, there are no modalities to evaluate these simultaneously. This preclinical study examined the possibility of an endoscopic barostat. Methods: Ultrathin endoscopy and our newly developed pressure-regulated endoscopic insufflator, which insufflates the gastrointestinal tract until the preset pressure is achieved, were used. The actual intragastric pressure was measured using an optical fiber manometer placed in the stomach. Experiment-1: in an ex vivo experiment, we insufflated the isolated stomach and verified whether the intragastric pressure reached the preset pressure. Experiment-2: we inserted the endoscope orally in a porcine stomach, insufflated the stomach, and verified whether the intragastric pressure reached the preset pressure. Finally, we insufflated the stomach at a random pressure to verify the functional tests for proof-of-concept. Results: Experiment-1: the intragastric pressure reached the preset pressure. After reaching the plateau, the pressure remained stable at the preset pressure (Huber M-value: 1.015, Regression line: 0.988, 95% confidence interval [CI]: 0.994–0.994). Experiment-2: the intragastric pressure reached the preset pressure. After reaching the plateau, the pressure remained stable at the preset pressure (Huber M-value: 1.018, Regression line: 0.971, 95% CI: 0.985–0.986). At randomly preset pressures, the transendoscopic theoretical intragastric pressure detected by the insufflator was correlated with the actual pressure measured by the pressure manometer. Conclusions: This proof-of-concept study shows that a pressure-regulated endoscopic insufflator provides stable intragastric pressure at the preset level, with the potential of an endoscopic barostat to assess visceral the hypersensitivity related to functional dyspepsia.

Measurement of intragastric pressure: an objective method to ascertain whether gastric wall extension is sufficient for assessment of the non-extension sign

Background and study aims The optimal intragastric pressure (IP) for strong gastric wall extension is unclear. We aimed to develop an accurate method to measure IP using endoscopy and determine the pressure required for strong gastric wall extension. Methods An in vitro experiment using an endoscope with a rubber attached at its tip was conducted. The process of inserting the pressure measurement probe into the forceps channel was skipped, and the tube of the pressure measurement device was directly connected to the forceps channel. In vivo, the pressure in 51 consecutive patients at the time of strong gastric wall extension was measured. Strong extension of the gastric wall was defined as when the folds in the greater curvature were flattened as a result of sufficient extension of the gastric wall by insufflated air during upper gastrointestinal endoscopy. The IP at that time was measured. Results In vitro, 20 mL of tap water was injected once into the forceps channel and then aspirated for 10 seconds. Pressure measurement after irrigation of the forceps channel as well as the measurement by inserting the probe procedure were accurately performed. In vivo, among the 51 included patients, the mean IP (range) was 14.7 mmHg (10–23). Strong extension of the gastric wall was obtained in 96.1 % of patients when the IP was 20 mmHg. Conclusions We developed an accurate method to measure IP using upper gastrointestinal endoscopy. Strong extension of the gastric wall was obtained in almost all patients when the IP was 20 mmHg.

Endokinin A/B stimulates rat gastric motility through myogenic NK1 receptors located in the fundus

Endokinin A/B (EKA/B), the common C-terminal decapeptide in endokinins A and B, is a preferred ligand of the NK1 receptor and regulates pain and itch. The study focused on the effects of EKA/B on rat gastric motility in vivo and in vitro. Gastric emptying was measured to evaluate gastric motility in vivo. Intragastric pressure and the contraction of gastric muscle strips were measured to evaluate gastric motility in vitro. Moreover, various neural blocking agents and neurokinin receptor antagonists were applied to explore the mechanisms. TAC4 and TACR1 mRNAs were expressed throughout rat stomach. EKA/B promoted gastric emptying by intraperitoneal injection in vivo. Correspondingly, EKA/B also increased intragastric pressure in vitro. Additionally, EKA/B contracted the gastric muscle strips from the fundus but not from the corpus or antrum. Further studies revealed that the contraction induced by EKA/B on muscle strips from the fundus could be significantly reduced by NK1 receptor antagonist SR140333 but not by NK2 receptor antagonist, NK3 receptor antagonist, or the neural blocking agents used. Our results suggested that EKA/B might stimulate gastric motility mainly through the direct activation of myogenic NK1 receptors located in the fundus.

N-SLEEVE GASTRECTOMY: AN OPTION FOR OBESITY AND GERD

ABSTRACT Background: Obesity represents a growing threat to population health all over the world. Laparoscopic sleeve gastrectomy induces alteration of the esophagogastric angle due to surgery itself, hypotony of the lower esophageal sphincter after division of muscular sling fibers, decrease of the gastric volume and, consequently, increase of intragastric pressure; that’s why some patients have reflux after sleeve. Aim: To describe a technique and preliminary results of sleeve gastrectomy with a Nissen fundoplication, in order to decrease reflux after sleeve. Method: In the current article we describe the technique step by step mostly focused on the creation of the wrap and it care. Results: This procedure was applied in a case of 45 BMI female of 53 years old, with GERD. An endoscopy was done demonstrating a hiatal hernia, and five benign polyps. A Nissen sleeve was performed due to its GERD, hiatal hernia and multiple polyps on the stomach. She tolerated well the procedure and was discharged home uneventfully 48 h after. Conclusion: N-sleeve is a feasible and safe alternative in obese patients with reflux and hiatal hernia when Roux-en-Y gastric bypass it is not indicated.

PS01.077: GASTRIC NECROSIS WITH PERFORATION AS LATE COMPLICATION OF NISSEN FUNDUPLICATION

Background Gastric necrosis and perforation after Nissen funduplication is a rare and life-treatening complication. Prompt diagnosis of acute gastric dilatation is mandatory to avoid gastric necrosis. A tight funduplication can cause a gastric dilatation because of the inability to vomit. Other causes of gastric dlatation include trauma, volvulus, anorexia and bulimia diabetes, polyphagia, acute infections and others. Methods A 56-year-old man was admited to emergency room with acute-onset epigastric pain and persistent nausea for the past 4 hours. Nine years ago he underwent a laparosocpic Nissen-Rossetti funduplication for a reflux disease.The examination showed abdominal distension and defense. Computed tomography of the abdomen (TAC) show a important pneumoperitoneum distributed diffusely throughout the abdomen, marked gastric distension with abundant content inside. Free intraperitoneal fluid and postsurgical changes in relation to Nissen fundoplication. An emergentcy laparotomy was indicated. Results Emergency laparotomy showed free peritoneal fluid with gastric dilatation and two areas of necrosis and perforation (localized in fundus and gastric body). We performed a total gastrectomy with esophagojejunal anastomosis. The patient sufferd a pulmonary embolism 8 days after laparotomy Pathological examination reported gastric dilatation and two areas of ischemia and trasnmural necrosis with perforation and peritonitis. Conclusion If the intragastric pressure excede gastric venous pressure can result in ischaemia and infarctation.Increased intragastric pressure is usually the result of a closed loop, secondary to mechanical compresion of the cardio-esophageaal and pyloroduodenal junctions, as can occur in patients with a Nissen procedure. CONCLUSION: Early diagnosis of gastric dilatation in these patients is mandatory to avoid major complications. Disclosure All authors have declared no conflicts of interest.