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Related Experiment Video

Updated: Jul 18, 2026

Robotic Myotomy and Partial Fundoplication for Achalasia

Robotic Myotomy and Partial Fundoplication for Achalasia

Published on: August 11, 2023

Endoluminal fundoplication--the Hill procedure.

Annette Fritscher-Ravens¹, Paul Swain

¹Department of Endoscopy, Homerton University Hospital, London, UK.

Minimally Invasive Therapy & Allied Technologies : MITAT : Official Journal of the Society for Minimally Invasive Therapy

|December 28, 2006

Summary

Endoscopic ultrasound (EUS) enabled transgastric surgery to place stitches, significantly increasing lower esophageal sphincter pressure in pigs. This novel approach shows promise for reflux treatment by manipulating structures outside the gut wall.

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Technical Considerations and Approach to Redo Foregut Surgery

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Published on: September 22, 2023

Area of Science:

Gastroenterology
Minimally Invasive Surgery
Medical Imaging

Background:

Current endoluminal reflux operations lack visualization and manipulation of extra-intestinal structures.
Endoscopic ultrasound (EUS) offers potential for visualizing and interacting with these structures.

Purpose of the Study:

Define EUS-anatomy of reflux-influencing extra-intestinal structures.
Assess feasibility of transgastric suturing of the median arcuate ligament (MAL) and crural repair under EUS guidance.
Evaluate EUS-guided posterior gastropexy (Hill procedure).

Main Methods:

Survival experiments in 14 pigs using linear array echo-endoscopes.
EUS-guided identification and suturing of the MAL and right crus.
Utilized an endoscopic sewing device for transgastric suturing, knot-tying, and thread-cutting.
Pre- and post-procedure manometry to assess lower esophageal sphincter (LES) pressure and length.

Main Results:

Successfully visualized and sutured the MAL and right crus under EUS control.
Achieved a significant increase in median LES pressure from 11 to 21 mm/Hg (p = 0.0028).
Increased median LES length from 2.8 cm to 3.5 cm post-procedure.
Demonstrated a median pull-out force of 2.8 kg for tags anchored in the MAL.

Conclusions:

Transgastric gastro-esophageal reflux surgery using EUS-guided stitching is feasible in pigs.
This technique can significantly enhance lower esophageal sphincter pressure.
EUS provides a platform for novel endoluminal surgical interventions for reflux disease.