Abstract
Purpose
Endoscopic treatment of reflux has been described. However, it is not equivalent to fundoplication. We describe a modified endoscope (Medi-Gus SRS gastroscope) which constructs a partial fundoplication using a transoral approach, and its evaluation in a porcine model.
Methods
The device is a video gastroscope with stapling mechanism and ultrasonic sights. It is inserted via the oesophagus into the stomach, and then acutely retroflexed, to push the fundus against the intra-oesophageal shaft of the device – contains a stapler cartridge. Ultrasonic sights ensure alignment.The anvil of the stapler (in the scope tip) and scope shaft are locked and staples are deployed, attaching the fundus to the left side of the oesophagus. The device is then reapplied, with 90 –120 degree rotation, attaching the fundus to the front of the oesophagus, constructing an anterior fundoplication. The device was evaluated in an independently monitored study. Twelve 70 – 80 kg pigs underwent fundoplication. Pigs were killed at 2, 4 and 6 wks (4 per group). 4 additional pigs underwent a sham procedure.
Results
Initial ex-vivo experiments showed that the fundoplication prevented reflux, and survival studies showed that the staples held the fundoplication in place (for up to 13 mths). In the final experiment, each stapling took between 5 –10 mins, and total procedure time ranged from 30 – 60 mins.There were no complications. Endoscopy and autopsy confirmed a satisfactory anterior fundoplication in all instances.
Conclusions
In a pig model the MediGus SRS gastroscope can be used to fashion an anterior fundoplication. Further clinical evaluation is appropriate
Endoscopic treatment of reflux has been described. However, it is not equivalent to fundoplication. We describe a modified endoscope (Medi-Gus SRS gastroscope) which constructs a partial fundoplication using a transoral approach, and its evaluation in a porcine model.
Methods
The device is a video gastroscope with stapling mechanism and ultrasonic sights. It is inserted via the oesophagus into the stomach, and then acutely retroflexed, to push the fundus against the intra-oesophageal shaft of the device – contains a stapler cartridge. Ultrasonic sights ensure alignment.The anvil of the stapler (in the scope tip) and scope shaft are locked and staples are deployed, attaching the fundus to the left side of the oesophagus. The device is then reapplied, with 90 –120 degree rotation, attaching the fundus to the front of the oesophagus, constructing an anterior fundoplication. The device was evaluated in an independently monitored study. Twelve 70 – 80 kg pigs underwent fundoplication. Pigs were killed at 2, 4 and 6 wks (4 per group). 4 additional pigs underwent a sham procedure.
Results
Initial ex-vivo experiments showed that the fundoplication prevented reflux, and survival studies showed that the staples held the fundoplication in place (for up to 13 mths). In the final experiment, each stapling took between 5 –10 mins, and total procedure time ranged from 30 – 60 mins.There were no complications. Endoscopy and autopsy confirmed a satisfactory anterior fundoplication in all instances.
Conclusions
In a pig model the MediGus SRS gastroscope can be used to fashion an anterior fundoplication. Further clinical evaluation is appropriate
| Original language | English |
|---|---|
| Article number | HP014 |
| Pages (from-to) | A37-A38 |
| Number of pages | 2 |
| Journal | ANZ Journal of Surgery |
| Volume | 76 |
| Issue number | s1 |
| DOIs | |
| Publication status | Published - 3 May 2006 |
| Event | RACS Annual Scientific Congress, 2006 - Duration: 16 May 2006 → … |
Keywords
- upper gastrointestinal tract
- surgery
- fundoplication
- reflux