• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
  • Skip to footer

SAGES

Reimagining surgical care for a healthier world

  • Home
    • COVID-19 Annoucements
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Who is SAGES?
    • SAGES Mission Statement
    • Strategic Plan, 2020-2023
    • Committees
      • Request to Join a SAGES Committee
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Full Committee Rosters
      • SAGES Past Presidents
    • Donate to the SAGES Foundation
    • Awards
      • George Berci Award
      • Pioneer in Surgical Endoscopy
      • Excellence In Clinical Care
      • International Ambassador
      • IRCAD Visiting Fellowship
      • Social Justice and Health Equity
      • Excellence in Community Surgery
      • Distinguished Service
      • Early Career Researcher
      • Researcher in Training
      • Jeff Ponsky Master Educator
      • Excellence in Medical Leadership
      • Barbara Berci Memorial Award
      • Brandeis Scholarship
      • Advocacy Summit
      • RAFT Annual Meeting Abstract Contest and Awards
  • Meetings
    • NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2023 Scientific Session Call For Abstracts
      • 2023 Emerging Technology Call For Abstracts
    • SAGES 2021 Annual Meeting
    • CME Claim Form
    • Industry
      • Advertising Opportunities
      • Exhibit Opportunities
      • Sponsorship Opportunities
    • Future Meetings
    • Past Meetings
      • SAGES 2021
      • SAGES 2020
      • SAGES 2019
      • SAGES 2018
    • Related Meetings Calendar
  • Join SAGES!
    • Membership Benefits
    • Membership Applications
      • Active Membership
      • Affiliate Membership
      • Associate Active Membership
      • Candidate Membership
      • International Membership
      • Medical Student Membership
    • Member News
      • Member Spotlight
      • Give the Gift of SAGES Membership
  • Patients
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Patient Information Brochures
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find a SAGES Member
  • Publications
    • SAGES Stories Podcast
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • SCOPE – The SAGES Newsletter
    • COVID-19 Annoucements
    • Troubleshooting Guides
  • Education
    • OpiVoid.org
    • SAGES.TV Video Library
    • Safe Cholecystectomy Program
      • Safe Cholecystectomy Didactic Modules
    • Masters Program
      • SAGES Facebook Program Collaboratives
      • Acute Care Surgery
      • Bariatric
      • Biliary
      • Colorectal
      • Flexible Endoscopy (upper or lower)
      • Foregut
      • Hernia
      • Robotics
    • Educational Opportunities
    • HPB/Solid Organ Program
    • Courses for Residents
      • Advanced Courses
      • Basic Courses
    • Video Based Assessments (VBA)
    • Robotics Fellows Course
    • MIS Fellows Course
    • Facebook Livestreams
    • Free Webinars For Residents
    • SMART Enhanced Recovery Program
    • SAGES OR SAFETY Video
    • SAGES at Cine-Med
      • SAGES Top 21 MIS Procedures
      • SAGES Pearls
      • SAGES Flexible Endoscopy 101
      • SAGES Tips & Tricks of the Top 21
  • Opportunities
    • SAGES Fellowship Certification for Advanced GI MIS and Comprehensive Flexible Endoscopy
    • Foregut Fellowship Certification
    • SAGES Research Opportunities
    • Fundamentals of Laparoscopic Surgery
    • Fundamentals of Endoscopic Surgery
    • Fundamental Use of Surgical Energy
    • Job Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
  • Store
    • SAGES Logo Products
    • “Unofficial” Logo Products
  • Log In

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.

182

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Pinterest
  • WhatsApp
  • Reddit

Related

« Return to SAGES 2015 abstract archive

Our Mission

Innovate, educate and collaborate to improve patient care.

Recently, on SAGES…

Surgery is Safer with Vaccination 1

Addressing Religious Concerns About COVID-19 Vaccine

This may be a difficult subject matter for you and your patient to talk about.  Be assured, all major organized religious groups encourage and recommend the COVID-19 vaccine. Listed below are references and websites you can direct your patient towards to help them make an informed decision with regards to their religious concerns against the […]

SAGES Statement on AAPI Violence

The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) stands in solidarity with the Asian American and Pacific Islander (AAPI) community. In the summer of 2020, SAGES released a statement condemning the violence, racism, and hatred toward the Black community in the wake of George Floyd and Breonna Taylor’s murders. It is with great sorrow […]

Free SAGES Webinar: Lessons from COVID on Living and Thriving as Surgeons

SAGES recognizes that the COVID-19 pandemic has had a big impact on surgical practice and in surgeon wellness. SAGES’ Reimagining the Practice of Surgery Taskforce will present “Finding the Opportunities: Lessons from COVID and How We Live and Thrive as Surgeons”  to look at ways in which innovative leadership at various levels may help transform […]

Contact SAGES

Society of American Gastrointestinal and Endoscopic Surgeons
11300 W. Olympic Blvd Suite 600
Los Angeles, CA 90064 USA
[email protected]
Tel: (310) 437-0544

Find Us Around the Web!

  • Facebook
  • Twitter
  • YouTube

Important Links

SAGES 2022 Meeting Information

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals

 

  • taTME Study Info
  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

Copyright © 2022 Society of American Gastrointestinal and Endoscopic Surgeons