Peroral endoscopic full and partial-thickness myotomy. A viability study in an animal model

Abstract

Background: Peroral endoscopic myotomy has recently been developed and performed on patients with good results. Aims: To evaluate the technical feasibility of peroral endoscopic full-thickness and partial thickness myotomy in a porcine model. Material and methods: Eighteen criollo pigs were randomly assigned to 2 groups: group A (partial-thickness myotomy) and group B (full-thickness myotomy). The mucosal defect proximal to the myotomy site was left open. On the seventh postoperative day the pig was euthanized and follow-up surgical exploration was performed. The duration of each procedure, postoperative progression of the animal, complications, and anatomopathologic findings were registered. Results: The procedure was viable in all the pigs. The mean surgery duration was 81 ± 35.3 min (group A 51.11 ± 11.12, group B 111 ± 22.61; P < .05). The main complication during myotomy was subcutaneous emphysema (16%). The histopathologic study of the group A surgical specimens reported complete circular myotomy in all cases, and complete circular and longitudinal myotomy was reported in 100% of the group B sample. Conclusions: The endoscopic myotomy technique is feasible. Endoscopic partial-thickness myotomy was associated with shorter surgery duration and better results during the intraoperative period and the 7-day follow-up.

Keywords

• Peroral endoscopic myotomy
• Peroral endoscopic full-thickness myotomy
• Peroral endoscopic partial-thickness myotomy
• Porcine model