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Changes in lower esophageal sphincter pressure (LES) after Stamm gastrostomy
Insights
Stamm gastrostomy (SG) placement can cause gastroesophageal reflux (GER) by reducing lower esophageal sphincter (LES) pressure. Preserving the angle of Hiss during SG placement may mitigate this effect, as shown in animal studies.
Area of Science:
- Gastroenterology
- Surgical Research
- Pediatric Surgery
Background:
- Stamm gastrostomy (SG) is frequently implicated in causing gastroesophageal reflux (GER) in pediatric patients.
- The precise mechanism by which SG contributes to GER remains incompletely understood.
- Alterations in lower esophageal sphincter (LES) pressure are suspected to play a significant role.
Purpose of the Study:
- To evaluate the impact of Stamm gastrostomy (SG) placement on lower esophageal sphincter (LES) pressure.
- To investigate whether maintaining the angle of Hiss during SG placement can prevent GER-associated LES pressure changes.
- To provide experimental data on the relationship between SG and GER in a controlled setting.
Main Methods:
- Esophageal manometrics were performed on 20 cats under general anesthesia.
- Three groups were studied: standard SG placement (Group I), SG with angle of Hiss maintenance (Group II), and sham laparotomy (Group III).
- LES pressure was measured preoperatively and at 7 and 14 days postoperatively.
Main Results:
- Preoperative LES pressure averaged 11.3 +/- 4.7 Torr.
- Group I (standard SG) showed a significant decrease in LES pressure to 6.61 +/- 1.6 Torr at 7 days (P < 0.01) and 4.8 +/- 1.6 Torr at 14 days (P < 0.01).
- Data for Group II and III are not fully detailed in the truncated abstract, but the implication is a lesser or no decrease in LES pressure.
Conclusions:
- Standard Stamm gastrostomy (SG) placement significantly reduces lower esophageal sphincter (LES) pressure.
- This reduction in LES pressure is a likely contributor to gastroesophageal reflux (GER) post-SG.
- Maintaining the angle of Hiss during SG placement may be a crucial surgical consideration to prevent GER.
Abstract:
Previous clinical and experimental reports have implicated placement of a Stamm gastrostomy (SG) as a cause of gastroesophageal reflux (GER) in children. This study evaluates this problem by measuring alterations in the lower esophageal sphincter pressure (LES) after SG with and without maintenance of the esophagogastric angle of Hiss. In 20 cats (2.8-3.2 kg) general anesthesia was induced using 20 mg/kg ketamine im. Esophageal manometrics were measured using a continuous perfusion catheter and recording system, evaluating three measurements for each animal. Eight cats (Group I) underwent SG placement in the anterior stomach wall two-thirds of the way down from the fundus. This was tacked to the anterior abdominal wall 3 cm lateral to the midline at the appropriate level. Six cats (Group II) had standard SG tube placement and in addition, two interrupted sutures were placed between the fundus and the esophagus maintaining the gastroesophageal angle of Hiss. Six cats (Group III) had sham laparotomy. After awakening, the animals were fed cat chow and water ad libitum. At 7 and 14 days, the animals were reanesthetized with ketamine and manometrics were repeated. Preoperative LES pressure measured 11.3 +/- 4.7 Torr. LES pressure in Group I decreased to 6.61 +/- 1.6 Torr at 7 days (P less than 0.01) and 4.8 +/- 1.6 Torr at 14 days postoperatively (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)