Study On Therapeutic Endoscopy For Gastroesophageal Reflux Disease: Perabdominal Transgastric Approach And Minimal Invasive Method

Objective: To reproduce gastroesophageal reflux disease (GERD) animal model by balloon dilatation and to investigate an effective, safe,reliable method and minimal invasive therapeutic endoscopy for the treatment of GERD.Methods: Balloon dilatation was carried out for 50 New Zealand rabbits to reproduce the model of GERD. The middle of balloon was placed at the gastroesophageal junction. The pressure of dilatation was 10 Psi(l Psi=6.89 kPa)and dilatation was maintained for 10 min and the second dilatation was performed after 3 min. 32 rabbits with GERD model were chose and randomly divided into two groups: therapy group (20 rabbits)and control group (12 rabbits). The rabbits in therapy group were underwent cardia suturing perabdominal transgastric approach, rabbits in control group were established the perabdominal transgastric approach only. Esophageal manometry and esophageal pH monitoring were performed in all animals one week before dilatation and two weeks after dilatation and two weeks after operation. Pathological examination was carried out in some rabbits in different time. The incisions and sutures were observed after operation.Results: 32 rabbits with GERD model were reproduced. The LES pressures before and after dilatation were (11.12±1.37) mmHg and (7.96±2.14)mmHg, and there was significant difference between before and after dilatation in the LES pressure (t=9.24, P=0.000).The reflux ratios before and after dilatation were (1.08±0.84) % and (6.07±3.79) %, showed a significant difference (t=8.58, P=0.000).The perabdominal transgastric approach and cardiac operation was performed for 20 rabbits respectively, and the success rate was 62.5 percents. The LES pressures of therapy group and control group two weeks after operation were (9.82±0.89) mmHg and (7.87±1.55) mmHg, and there was significant difference (t=3.58, P=0.002). The reflux ratios of therapy group and control group were (2.58±1.16) % and (7.91±2.96) %, showed a significant difference (t=5.67, P=0.000). There were obvious pathological changes in esophagus in different time. Incisions of belly and gastric wall cicatrized well, sutures still existed.Conclusion: 1.Perabdominal transgastric cardia suturing is an effective, safe and reliable method and minimal invasive therapeutic endoscopy for the treatment of GERD and 2.Balloon dilatation is a new, easy, reliable and minimal invasive method to reproduce GERD mode...