• Skip to main content
  • Skip to header right navigation
  • Skip to site footer

Log in
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
www.sages.org

SAGES

Reimagining surgical care for a healthier world

  • Home
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Awards
    • Who Is SAGES?
    • Leadership
    • Our Mission
    • Advocacy
    • Committees
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Committee Rosters
      • SAGES Past Presidents
  • Meetings
    • SAGES NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2026 Scientific Session Call for Abstracts
      • 2026 Emerging Technology Call for Abstracts
    • CME Claim Form
    • SAGES Past, Present, Future, and Related Meeting Information
    • SAGES Related Meetings & Events Calendar
  • Join SAGES!
    • Membership Application
    • Membership Benefits
    • Membership Types
      • Requirements and Applications for Active Membership in SAGES
      • Requirements and Applications for Affiliate Membership in SAGES
      • Requirements and Applications for Associate Active Membership in SAGES
      • Requirements and Applications for Candidate Membership in SAGES
      • Requirements and Applications for International Membership in SAGES
      • Requirements for Medical Student Membership
    • Member Spotlight
    • Give the Gift of SAGES Membership
  • Patients
    • Join the SAGES Patient Partner Network (PPN)
    • Patient Information Brochures
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find A SAGES Surgeon
  • Publications
    • Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Sustainability in Surgical Practice
    • SAGES Stories Podcast
    • Patient Information Brochures
    • Patient Information From SAGES
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • MesSAGES – The SAGES Newsletter
    • COVID-19 Archive
    • Troubleshooting Guides
  • Education
    • Wellness Resources – You Are Not Alone
    • Avoid Opiates After Surgery
    • SAGES Subscription Catalog
    • SAGES TV: Home of SAGES Surgical Videos
    • The SAGES Safe Cholecystectomy Program
    • Masters Program
    • Resident and Fellow Opportunities
      • MIS Fellows Course
      • SAGES Robotics Residents and Fellows Courses
      • SAGES Free Resident Webinar Series
      • Fluorescence-Guided Surgery Course for Fellows
      • Fellows’ Career Development Course
    • SAGES S.M.A.R.T. Enhanced Recovery Program
    • SAGES @ Cine-Med Products
      • SAGES Top 21 Minimally Invasive Procedures Every Practicing Surgeon Should Know
      • SAGES Pearls Step-by-Step
      • SAGES Flexible Endoscopy 101
    • SAGES OR SAFETY Video Activity
  • Opportunities
    • Fellowship Recognition Opportunities
    • SAGES Advanced Flexible Endoscopy Area of Concentrated Training (ACT) SEAL
    • Multi-Society Foregut Fellowship Certification
    • Research Opportunities
    • FLS
    • FES
    • FUSE
    • Jobs Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • OWLS/FLS
You are here: Home / Abstracts / Understanding Pyloric Sphincter Activity Using a Distensibility Technique

Understanding Pyloric Sphincter Activity Using a Distensibility Technique

Jorge Alberto Arroyo Vazquez, MD1, Per-Ola Park, MD, Professor1, Maria Bergstrom, MD, PhD1, Steven Bligh2, Barry P McMahon, PhD2. 1Dept of Surgery, South Alvsborg Hospital & Gothenburg University, 2Trinity Academic Gastroenterology Group, Trinity College & Tallaght Hospital, Dublin, Ireland

Background

Limited data is available to fully describe the function of the pyloric sphincter. It is clear that its primary role is in gastric emptying and the control of stomach contents. Stent treatment of duodenal perforated ulcers has been tried out with good clinical results but stent migration has occurred in a few cases. Our theory is that the stent itself causes an increased pressure in the pyloric sphincter initiating emptying sphincteric actions. The aim of the study was to investigate whether distending the pyloric sphincter with the functional lumen imaging probe (FLIP) would provide a better understanding of the pyloric sphincter physiology. The effect of Neostigmine on the sphincter function was also studied.

Method

Four female pigs (40-50 kg) were acquired for the study which had ethical approval. The pigs were anaesthetised and gastroscoped. The EndoFLIP™ Catheter EF-353 (Crospon, Galway, Ireland) was inserted through the scope and placed in the pylorus. To aid positioning a small volume of 20 to 30 ml was filled into the catheter and probe position was adjusted by viewing the EndoFLIP screen and observing the hourglass shape. It was decided that the optimal position would be when the probes 16 measurement were straddling the pyloric sphincter so that the central measurements represent the narrowest region in the middle. Stepwise volume controlled distensions to balloon fill volumes of 20ml, 30ml, 40ml and 50ml were carried out. The volumes were maintained for 1 min and the complete step protocol was repeated. 1.5mg of neostigmine was then administered intravenously and no measurements were taken for 5 minutes to allow for the effect of the drug to occur. The stepwise volume controlled distensions were then repeated.

Results

The EndoFLIP catheter could successfully be inserted into the pylorus and infused with a liquid volume. Initial distensions clearly indicated that it was easy to locate the probe straddling the pylorus. Patterns of motility observed at all bag volume levels indicated a constant rhythmic opening of the narrowest region in the pyloric sphincter while simultaneous a drop in pressure in the bag was observed, indicating that the movement was specifically of an opening and closing nature and not similar to peristaltic wave movement observed in other parts of the GI tract. Plots of narrowest CSA (Cross Sectional Area) and bag pressure during the 1 minute volume hold period indicated that as volume increased the opening patterns grew larger and the pressure increased, consistent with a valvular region that is relatively compliant. A plot of distensibility at the step volumes before and after neostigmine administration indicates that the pylorus becomes more distensible after the administration.

Conclusion

The FLIP can easily be used through a gastroscope for assessing the pyloric sphincter physiology. The sphincter seems to be compliant; it relaxes more and opens more widely after larger volume distensions. This might influence pyloric actions during stent treatment. Possibly larger and stronger stents induce more emptying activity leading to more stent migration.

206

Share this:

  • Click to share on X (Opens in new window) X
  • Click to share on Facebook (Opens in new window) Facebook
  • Click to share on LinkedIn (Opens in new window) LinkedIn
  • Click to share on Pinterest (Opens in new window) Pinterest
  • Click to share on WhatsApp (Opens in new window) WhatsApp
  • Click to share on Reddit (Opens in new window) Reddit
  • Click to share on Pocket (Opens in new window) Pocket
  • Click to share on Mastodon (Opens in new window) Mastodon
  • Click to share on Threads (Opens in new window) Threads
  • Click to share on Bluesky (Opens in new window) Bluesky

Related


sages_adbutler_leaderboard

Hours & Info

11300 West Olympic Blvd, Suite 600
Los Angeles, CA 90064

1-310-437-0544

[email protected]

Monday – Friday
8am to 5pm Pacific Time

Find Us Around the Web!

  • Bluesky
  • X
  • Instagram
  • Facebook
  • YouTube

Copyright © 2025 · SAGES · All Rights Reserved

Important Links

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals