Endoscopic sclerosis of the cardia affects gastroesophageal reflux (original) (raw)

Summary

Gastroesophageal reflux disease remains a disorder of unknown etiology associated with abnormal function of the lower esophageal sphincter (LES) and other physiological co-factors of the pathologic reflux. Effective operations for reflux are designed to reinforce the anti-reflux barrier and alter the tendency towards abnormal reflux. We have postulated that the most important component of these procedures is the prevention of distraction of the lowermost components of the LES at the onset of a potential reflux episode. Distraction of the LES causes shortening of the effective sphincter mechanism and can initiate experimental reflux events. In this study we used endoscopic sclerosis of the submucosal space at the cardia as a means of reducing distraction of the cardia in the hope that this would reduce abnormal reflux events. Canine gastroesophageal reflux was induced by intravenous atropine and monitored by continuous esophageal pH monitoring. Sclerosis of the cardia prevented gastroesophageal reflux, without measurable effect on the LES pressure or length. Endoscopic sclerosis of the cardia may be a useful technique in the control of human gastroesophageal reflux.

Access this article

Log in via an institution

Subscribe and save

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Donahue PE, Samelson S, Nyhus LM, Bombeck CT (1985) The Floppy Nissen Fundoplication — effective long-term control of pathologic reflux. Arch Surg 120: 721–730
    Google Scholar
  2. O'Connor KW, Lehman GA (1988) Endoscopic placement of collagen at the lower esophageal sphincter to inhibit gastroesophageal reflux: a pilot study of 10 medically intractable patients. Gastrointest Endosc 34: 106–112
    Google Scholar
  3. O'Connor KW, Madison SA, Smith DJ, Ransburg RC, Lehman GA (1984) An experimental endoscopic technique for reversing gastroesophageal reflux in dogs by injecting inert material in the distal esophagus. Gastrointest Endosc 30: 275–280
    Google Scholar
  4. O'Sullivan GC, DeMeester TR, Joelsson BE, Smith RB, Blough RR, Johnson LF, Skinner DB (1982) Interaction of lower esophageal sphincter pressure and length of sphincter in the abdomen as determinants of gastroesophageal competence. Am J Surg 143: 40–48
    Google Scholar
  5. Pettersson GB, Bombeck CT, Nyhus LM (1980) The lower esophageal sphincter. Mechanisms of opening and closure. Surgery 88: 307–313
    Google Scholar
  6. Pettersson GB, Bombeck CT, Nyhus LM (1980) The dynamics of lower esophageal function. Curr Surg 37: 143–145
    Google Scholar
  7. Samelson S, Abuabara SF, Bombeck CT (1982) The failing lower esophageal sphincter: a multivariate analysis. Gastroenterology 82: 1169a
  8. Soehendra N, Heer K de, Kempeneers I, Frommelt L (1983) Morphological alterations of the esophagus after endoscopic sclerotherapy of varices. Endoscopy 15: 291–296
    Google Scholar

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Cook County Hospital, Chicago, Illinois, USA
    Philip E. Donahue, C. Thomas Bombeck & Lloyd M. Nyhus
  2. Department of Surgery, Veterans Administration West Side Medical Center, Chicago, Illinois, USA
    Philip E. Donahue, Indrek Miidla, C. Thomas Bombeck & Lloyd M. Nyhus
  3. Department of Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
    Philip E. Donahue, Paulo Carvalho, Junichi Yoshida, Indrek Miidla, Y. -J. E. Shen, C. Thomas Bombeck & Lloyd M. Nyhus

Authors

  1. Philip E. Donahue
  2. Paulo Carvalho
  3. Junichi Yoshida
  4. Indrek Miidla
  5. Y. -J. E. Shen
  6. C. Thomas Bombeck
  7. Lloyd M. Nyhus

Rights and permissions

About this article

Cite this article

Donahue, P.E., Carvalho, P., Yoshida, J. et al. Endoscopic sclerosis of the cardia affects gastroesophageal reflux.Surg Endosc 3, 11–12 (1989). https://doi.org/10.1007/BF00591308

Download citation

Key words