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.
Similar content being viewed by others
References
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
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
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
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
Pettersson GB, Bombeck CT, Nyhus LM (1980) The lower esophageal sphincter. Mechanisms of opening and closure. Surgery 88: 307–313
Pettersson GB, Bombeck CT, Nyhus LM (1980) The dynamics of lower esophageal function. Curr Surg 37: 143–145
Samelson S, Abuabara SF, Bombeck CT (1982) The failing lower esophageal sphincter: a multivariate analysis. Gastroenterology 82: 1169a
Soehendra N, Heer K de, Kempeneers I, Frommelt L (1983) Morphological alterations of the esophagus after endoscopic sclerotherapy of varices. Endoscopy 15: 291–296
Author information
Authors and Affiliations
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
Issue Date:
DOI: https://doi.org/10.1007/BF00591308