A Prospective Randomized Trial to Assess the Antireflux Effect of Antireflux Mucosectomy in the Porcine Model

BACKGROUND: Both long-term proton pump inhibitor use and surgical fundoplication have potential drawbacks as treatments for chronic gastroesophageal reflux disease (GERD). Our aim was to investigate the potential efficacy of antireflux mucosectomy (ARMS) in porcine and determine the optimal circumference of resection in relation to gastroesophageal junction (GEJ). METHODS: Nine pigs were allocated into the following 3 groups by computerized randomization: group A: control, group B: 1/3 circumference of the esophagus, and group C: 2/3 circumference of the esophagus. We performed mucosectomy with a crescentic mucosal resection at 3 cm above the GEJ and 1 cm below the GEJ. The animals were kept on a liquid diet for 24 h prior to endoscopy. At 6 weeks, animals underwent esophagoscopy, barium radiography, gastric yield pressure (GYP), and gastric yield volume (GYV) determination. RESULTS: The weight of swines has no significant difference, and all pigs had maintained their weight after the procedure. We both found scar formation at the GEJ in group B and C. Compared with group A and B, group C produced significantly higher GYP (24.23 ± 3.42 mmHg, p = 0.004) and significantly smaller GYV (2200.0 ± 238.96 mL, p = 0.028) after 6 weeks. Barium radiography showed that the width of the cardia was narrower (13.73 ± 1.19 mm, p = 0.032) in group C after 6-week postprocedure. CONCLUSION: Our study demonstrated the potential antireflux effect of ARMS. We also recommend the 2/3 circumference resection of mucosa at 3 cm distance from the GEJ.