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Endoscopy after esophagectomy: Safety demonstrated in a porcine model.

Publication ,  Journal Article
Raman, V; Moodie, KL; Ofoche, OO; Kaiser, LR; Erkmen, CP
Published in: The Journal of thoracic and cardiovascular surgery
September 2017

Endoscopy is useful in assessing conduit ischemia and anastomotic leaks after esophagectomy but poses a theoretical threat of anastomotic disruption. We used a porcine model to evaluate the safety of endoscopy after esophagectomy.We performed esophagectomies in 10 live pigs and performed endoscopy with progressive air insufflation and continuous intraluminal pressure monitoring. We stopped insufflation when the intraluminal pressure reached a plateau. We assessed the integrity of the conduit and anastomosis via endoscopy. We also performed pulse oximetry of the stomach and Doppler velocimetry of the right gastroepiploic artery on 5 live pigs to study the effects of endoscopic gastric insufflation.With gentle air insufflation, there was no measurable increase in intraluminal pressure, disruption of the conduit or anastomosis, or significant gastric distension. With progressive insufflation, the intraluminal pressure reached a plateau at a maximum of 8.7 ± 2.1 cm H2O (95% confidence interval, 7.2-10.2). At this plateau, air leaked retrograde via the mouth, which prevented further gastric distension. There were no significant changes in oxyhemoglobin saturation along various regions in the stomach even with maximal insufflation sustained for 10 minutes. There was a momentary reduction in gastroepiploic flow from 12.0 ± 1.0 [95% confidence interval, 10.8-13.2] mL/min/100 g to 9.6 ± 1.5 [95% confidence interval, 7.8-11.4] mL/min/100 g immediately after maximal insufflation, but flow recovered to 11 ± 1.3 [9.6, 12.8] mL/min/100 g after 10 minutes of sustained insufflation.Endoscopy after esophagectomy with gentle or maximal air insufflation results in safe endoluminal pressures and minimal disturbance of blood flow and oxygenation.

Duke Scholars

Published In

The Journal of thoracic and cardiovascular surgery

DOI

EISSN

1097-685X

ISSN

0022-5223

Publication Date

September 2017

Volume

154

Issue

3

Start / End Page

1152 / 1158

Related Subject Headings

  • Swine
  • Stomach
  • Stents
  • Respiratory System
  • Metals
  • Esophagus
  • Esophagectomy
  • Endoscopy
  • Animals
  • Anastomosis, Surgical
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Raman, V., Moodie, K. L., Ofoche, O. O., Kaiser, L. R., & Erkmen, C. P. (2017). Endoscopy after esophagectomy: Safety demonstrated in a porcine model. The Journal of Thoracic and Cardiovascular Surgery, 154(3), 1152–1158. https://doi.org/10.1016/j.jtcvs.2016.12.053
Raman, Vignesh, Karen L. Moodie, Obinna O. Ofoche, Larry R. Kaiser, and Cherie P. Erkmen. “Endoscopy after esophagectomy: Safety demonstrated in a porcine model.The Journal of Thoracic and Cardiovascular Surgery 154, no. 3 (September 2017): 1152–58. https://doi.org/10.1016/j.jtcvs.2016.12.053.
Raman V, Moodie KL, Ofoche OO, Kaiser LR, Erkmen CP. Endoscopy after esophagectomy: Safety demonstrated in a porcine model. The Journal of thoracic and cardiovascular surgery. 2017 Sep;154(3):1152–8.
Raman, Vignesh, et al. “Endoscopy after esophagectomy: Safety demonstrated in a porcine model.The Journal of Thoracic and Cardiovascular Surgery, vol. 154, no. 3, Sept. 2017, pp. 1152–58. Epmc, doi:10.1016/j.jtcvs.2016.12.053.
Raman V, Moodie KL, Ofoche OO, Kaiser LR, Erkmen CP. Endoscopy after esophagectomy: Safety demonstrated in a porcine model. The Journal of thoracic and cardiovascular surgery. 2017 Sep;154(3):1152–1158.
Journal cover image

Published In

The Journal of thoracic and cardiovascular surgery

DOI

EISSN

1097-685X

ISSN

0022-5223

Publication Date

September 2017

Volume

154

Issue

3

Start / End Page

1152 / 1158

Related Subject Headings

  • Swine
  • Stomach
  • Stents
  • Respiratory System
  • Metals
  • Esophagus
  • Esophagectomy
  • Endoscopy
  • Animals
  • Anastomosis, Surgical