Effect of changes in intra-abdominal pressure on diameter, cross-sectional area, and distensibility of the lower esophageal sphincter of healthy dogs as determined by use of an endoscopic functional luminal imaging probe

Philipp D. Mayhew Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616.

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Kathryn A. Pitt Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616.

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Michele A. Steffey Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616.

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William T.N. Culp Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616.

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Philip H. Kass Department of Population Health and Reproduction, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616.

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Stanley L. Marks Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616.

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Abstract

OBJECTIVE To evaluate the effect of intra-abdominal pressure (IAP) on morphology and compliance of the lower esophageal sphincter (LES) by use of impedance planimetry in healthy dogs and to quantify the effect of changes in IAP.

ANIMALS 7 healthy, purpose-bred sexually intact male hound-cross dogs.

PROCEDURES Dogs were anesthetized, and cross-sectional area (CSA), minimal diameter (MD), LES length, LES volume, and distensibility index (DI) of the LES were evaluated by use of an endoscopic functional luminal imaging probe. For each dog, measurements were obtained before (baseline) and after creation of a pneumoperitoneum at an IAP of 4, 8, and 15 mm Hg. Order of the IAPs was determined by use of a randomization software program.

RESULTS CSA and MD at 4 and 8 mm Hg were not significantly different from baseline measurements; however, CSA and MD at 15 mm Hg were both significantly greater than baseline measurements. The LES length and LES volume did not differ significantly from baseline measurements at any IAP. The DI differed inconsistently from the baseline measurement but was not substantially affected by IAP.

CONCLUSIONS AND CLINICAL RELEVANCE Pneumoperitoneum created with an IAP of 4 or 8 mm Hg did not significantly alter LES morphology in healthy dogs. Pneumoperitoneum at an IAP of 15 mm Hg caused a significant increase in CSA and MD of the LES. Compliance of the LES as measured by the DI was not greatly altered by pneumoperitoneum at an IAP of up to 15 mm Hg.

Abstract

OBJECTIVE To evaluate the effect of intra-abdominal pressure (IAP) on morphology and compliance of the lower esophageal sphincter (LES) by use of impedance planimetry in healthy dogs and to quantify the effect of changes in IAP.

ANIMALS 7 healthy, purpose-bred sexually intact male hound-cross dogs.

PROCEDURES Dogs were anesthetized, and cross-sectional area (CSA), minimal diameter (MD), LES length, LES volume, and distensibility index (DI) of the LES were evaluated by use of an endoscopic functional luminal imaging probe. For each dog, measurements were obtained before (baseline) and after creation of a pneumoperitoneum at an IAP of 4, 8, and 15 mm Hg. Order of the IAPs was determined by use of a randomization software program.

RESULTS CSA and MD at 4 and 8 mm Hg were not significantly different from baseline measurements; however, CSA and MD at 15 mm Hg were both significantly greater than baseline measurements. The LES length and LES volume did not differ significantly from baseline measurements at any IAP. The DI differed inconsistently from the baseline measurement but was not substantially affected by IAP.

CONCLUSIONS AND CLINICAL RELEVANCE Pneumoperitoneum created with an IAP of 4 or 8 mm Hg did not significantly alter LES morphology in healthy dogs. Pneumoperitoneum at an IAP of 15 mm Hg caused a significant increase in CSA and MD of the LES. Compliance of the LES as measured by the DI was not greatly altered by pneumoperitoneum at an IAP of up to 15 mm Hg.

Contributor Notes

Address correspondence to Dr. Mayhew (philmayhew@gmail.com).
  • 1. Dallemagne B, Weerts JM, Jehaes C, et al. Laparoscopic Nissen fundoplication: preliminary report. Surg Laparosc Endosc 1991; 1: 138–143.

    • Search Google Scholar
    • Export Citation
  • 2. Kelley WE. Laparoscopic antireflux surgery. In: Wetter PA, ed. Prevention and management of laparoendoscopic surgical complications. 4th ed. Miami: Society of Laparoendoscopic Surgeons, 2012; Chapter 21, 408–441.

    • Search Google Scholar
    • Export Citation
  • 3. Broeders JA, Roks DJ, Ahmed Ali U, et al. Laparoscopic anterior 180-degree versus Nissen fundoplication for gastroesophageal reflux disease: systematic review and meta-analysis of randomized clinical trials. Ann Surg 2013; 257: 850–859.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4. Schijven MP, Gisbertz SS, van Berge Henegouwen MI. Laparoscopic surgery for gastroesophageal acid reflux disease. Best Pract Res Clin Gastroenterol 2014; 28: 97–109.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5. Rinsma NF, Smeets FG, Bruls DW, et al. Effect of transoral incisionless fundoplication on reflux mechanisms. Surg Endosc 2014; 28: 941–949.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6. Lorinson D, Bright RM. Long-term outcome of medical and surgical treatment of hiatal hernias in dogs and cats: 27 cases (1978–1996). J Am Vet Med Assoc 1998; 213: 381–384.

    • Search Google Scholar
    • Export Citation
  • 7. Prymak C, Saunders HM, Washabau RJ. Hiatal hernia repair by restoration and stabilization of normal anatomy. An evaluation in four dogs and one cat. Vet Surg 1989; 18: 386–391.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8. Callan MB, Washabau RJ, Saunders HM, et al. Congenital esophageal hiatal hernia in the Chinese Shar-Pei dog. J Vet Intern Med 1993; 7: 210–215.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9. Guiot LP, Lansdowne JL, Rouppert P, et al. Hiatal hernia in the dog: a clinical report of four Chinese Shar-Peis. J Am Anim Hosp Assoc 2008; 44: 335–341.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10. Mayhew PD. Recent advances in soft tissue minimally invasive surgery. J Small Anim Pract 2014; 55: 75–83.

  • 11. McMahon BP, Frøkjaer JB, Liao D, et al. A new technique for evaluating sphincter function in visceral organs: application of the functional lumen imaging probe (FLIP) for the evaluation of the oesophago-gastric junction. Physiol Meas 2005; 26: 823–836.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12. Perretta S, McAnena O, Botha A, et al. Acta from the EndoFLIP symposium. Surg Innov 2013; 20: 545–552.

  • 13. Hoppo T, McMahon BP, Witteman BP, et al. Functional lumen imaging probe to assess geometric changes in the esophagogastric junction following endolumenal fundoplication. J Gastrointest Surg 2011; 15: 1112–1120.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14. Kwiatek MA, Kahrilas K, Soper NJ, et al. Esophagogastric junction distensibility after fundoplication assessed with a novel functional luminal imaging probe. J Gastrointest Surg 2010; 14: 268–276.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15. Nathanson LK, Brunott N, Cavallucci D. Adult esophagogastric junction distensibility during general anesthesia assessed with an endoscopic functional luminal imaging probe (EndoFLIP). Surg Endosc 2012; 26: 1051–1055.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16. Ilczyszyn A, Botha AJ. Feasibility of esophagogastric junction distensibility measurement during Nissen fundoplication. Dis Esophagus 2014; 27: 637–644.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17. Tucker E, Sweis R, Anggiansah A, et al. Measurement of the esophago-gastric junction cross-sectional area and distensibility by an endolumenal functional lumen imaging probe for diagnosis of gastro-esophageal reflux disease. Neurogastroenterol Motil 2013; 25: 904–910.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18. Mayhew PD, Brown DC. Comparison of three techniques for ovarian pedicle hemostasis during laparoscopic-assisted ovariohysterectomy. Vet Surg 2007; 36: 541–547.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19. Teitelbaum EN, Boris L, Arafat FO, et al. Comparison of esophagogastric junction distensibility changes during POEM and Heller myotomy using intraoperative FLIP. Surg Endosc 2013; 27: 4547–4555.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20. Kamiike W, Taniguchi E, Iwase K, et al. Intraoperative manometry during laparoscopic operation for esophageal achalasia: does pneumoperitoneum affect manometry? World J Surg 1996; 20: 973–976.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 21. Yilmaz N, Musoglu A, Oner S, et al. Does an acute increase of intrabdominal pressure effect esophageal sphincter pressure? Hepatogastroenterology 2007; 54: 434–437.

    • Search Google Scholar
    • Export Citation
  • 22. Farré R, Silfrim D. Regulation of basal tone, relaxation and contraction of the lower oesophageal sphincter. Relevance to drug discovery for oesophageal disorders. Br J Pharmacol 2008; 153: 858–869.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 23. McMahon RL, Ali A, Chekan EG, et al. A canine model of gastroesophageal reflux disease (GERD). Surg Endosc 2002; 16: 67–74.

  • 24. Kwiatek MA, Pandolfino JE, Hirano I, et al. Esophagogastric junction distensibility assessed with an endoscopic functional luminal imaging probe (EndoFLIP). Gastrointest Endosc 2010; 72: 272–278.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 25. Rohof WO, Hirsch DP, Kessing BF, et al. Efficacy of treatment for patients with achalasia depends on the distensibility of the esophagogastric junction. Gastroenterology 2012; 143: 328–335.

    • Crossref
    • Search Google Scholar
    • Export Citation

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