| Background: The incidence of esophageal motility disorders has increased year by year.Taking achalasia as an example,in recent years,endoscopic treatment and surgery have initially solved the dysfunction of the LES relaxation and contraction.However,patients with esophageal aperistalsis suffer from the symptoms such as dysphagia and reflux.To restore esophageal peristalsis of achalasia patients by sequenced electric stimulation,an appropriate method must be established to implant the electrodes and pacemaker safely and effectively.We combined POEM(per-oral endoscopic myotomy)and abdominal wall puncture in pigs in order to explore a feasible procedure for the implantation.Materials and methods: In this study,healthy pigs were used,and esophageal submucosal tunnel was established from the esophagus at 12 o’clock from 5 cm above the gastroesophageal junction to the anterior wall of the stomach body near the small curve by oral endoscopic myotomy.According to the classic NOTES surgical procedure,cut the intrinsic muscular layer and serous membrane layer on the anterior wall of the gastric body near the small curve 7-8cm below the cardia,and at the same time,open the corresponding abdominal wall of the experimental pig,send the pair of sequential electrical pacing electrodes Enter the abdominal cavity,send the end of the electrical pacing electrode into the tunnel through the gastroscope and fix it to the correct position,clamp the opening of the esophageal tunnel and connect the opening of the abdominal wall.Through both direct observation and HRM of the esophagus,the movement and pressure changes of the esophagus of the experimental pigs during the electrical stimulation experiment were recorded.After electrical stimulation,continue to test the state of the experimental animals for several hours,kill and dissect the experimental animals,and observe the effects of the above operations.Then,the domestic pigs are subjected to different modes of electrical stimulation(based on 8ms,80 Hz,using different current strengths to stimulate the experimental pig esophagus;with 10 m A,80 Hz as base,using different pulse width stimulation;using 10 m A,5ms as the base,using different current frequencies for stimulation).Finally,the experimental pigs were sacrificed,and necropsy was performed to distinguish the absolute bleeding in their bodies.Results: The establishment of the esophagus submucosal tunnel of the experimental pigs was completed,and the esophageal electric pacemaker implantation process based on the tunnel technology was carried out smoothly.After the experiment completed,the vital signs of the experimental pig were stable.No obvious bleeding and major organ damage were seen.Esophageal intraluminal pressure changes after electrical stimulation were recorded using HRM.In the resting state,the pressure of the lower end of the esophagus of the pig is stable at 18.18±1.97 mm Hg.After the electrical stimulation occurs,the LES pressure of the experimental animal changes immediately only in the range of 3-12 m A current,1-7ms pulse width range and 40-70 Hz stimulation the frequency of esophageal pressure changes significantly.Conclusion: From this short follow-up animal study,it was found that the implantation of esophageal electrodes and pacemaker based on POEM and NOTES is feasible,safe,and effective.Nevertheless,there is urgent need for long-term followup to confirm or disprove the safety of the procedure.Electrical stimulation of the esophageal smooth muscle layer causing sequential electrical pacing established the theoretical basis for the treatment of achalasia and other esophageal motility disorders. |
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