Endoscopic truncal vagotomy. Exploring the fourth space. A technical feasibility study in a porcine model

Q3 Medicine

VideoGIE Pub Date : 2025-03-04 DOI:10.1016/j.vgie.2025.02.012

Kambiz Kadkhodayan MD , Shayan Irani MD

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引用次数: 0

Abstract

Background and Aims

Surgical truncal vagotomy is an effective treatment for refractory hyperacidity syndromes but is associated with significant perioperative risk, high cost, and morbidity. Endoscopic truncal vagotomy and EUS-guided vagal modulation may offer a minimally invasive alternative. In our porcine study, we evaluated the technical feasibility of endoscopic truncal vagotomy and EUS-guided targeting of the vagus nerves.

Methods

A Yorkshire pig weighing 170 lbs was used for the study under an institutional review board–approved protocol. EUS was first used to identify both the anterior and posterior vagus nerves. The nerves were tattooed using a fine-needle aspiration needle. A mucosotomy, submucosal tunnel, and full-thickness myotomy were used to access the periesophageal adventitia. A tunnel was then created in the esophageal adventitia (fourth space), and the vagus nerve was identified and transected. After transection, the mucosotomy was closed using hemostatic clips. The procedure was repeated for the anterior and posterior vagus nerves. Postprocedure necropsy confirmed accurate EUS-guided tattoo placement, complete nerve transection, and we evaluated for intraprocedural adverse events.

Results

The procedure was technically successful, with stable intraoperative vitals noted. On necropsy, both the anterior and posterior vagus nerves were accurately tattooed and completely transected in the lower esophagus. No evidence of leaks, mediastinal injury, or adverse events was observed.

Conclusions

This study demonstrates technical feasibility of (1) EUS-guided vagus nerve identification and targeting using a fine-needle aspiration as needed, and (2) endoscopic transection of both the anterior and posterior vagus nerves. Controlled dissection, low carbon dioxide insufflation, and meticulous technique are essential for safety. Further research is needed to refine the technique, assess safety and efficacy, and explore its full clinical potential.

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内窥镜迷走神经截切术。探索第四个空间。猪模型的技术可行性研究

背景和目的手术截断迷走神经是治疗难治性高酸性综合征的有效方法，但围手术期风险大，成本高，发病率高。内镜下迷走神经截切和eus引导下迷走神经调节可能是一种微创的替代方法。在我们的猪研究中，我们评估了内窥镜下迷走神经截切和eus引导下迷走神经靶向的技术可行性。方法根据机构审查委员会批准的方案，使用体重170磅的约克郡猪进行研究。EUS首先用于识别前迷走神经和后迷走神经。神经是用细针抽吸针刺的。采用粘膜切开术、粘膜下隧道和全层肌切开术进入食管周围外膜。然后在食管外膜（第四空间）建立一个隧道，并确定和横切迷走神经。横断后，使用止血夹关闭粘膜切开术。前迷走神经和后迷走神经重复此步骤。术后尸检证实了eus引导下纹身位置准确，神经完全横断，我们评估了术中不良事件。结果手术技术成功，术中生命体征稳定。在尸检中，前迷走神经和后迷走神经都被准确地刺穿，并在食管下部完全横断。没有观察到渗漏、纵隔损伤或不良事件的证据。结论本研究证明了以下技术的可行性：(1)eus引导下迷走神经识别和定位，根据需要使用细针穿刺；(2)内镜下前后迷走神经横断。控制解剖，低二氧化碳注入，和细致的技术是必不可少的安全。需要进一步的研究来完善技术，评估安全性和有效性，并探索其全部临床潜力。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

VideoGIE Medicine-Gastroenterology

CiteScore

1.50

自引率

0.00%

发文量

132

审稿时长

105 days

期刊介绍： VideoGIE, an official video journal of the American Society for Gastrointestinal Endoscopy, is an Open Access, online-only journal to serve patients with digestive diseases. VideoGIE publishes original, single-blinded peer-reviewed video case reports and case series of endoscopic procedures used in the study, diagnosis, and treatment of digestive diseases. Videos demonstrate use of endoscopic systems, devices, and techniques; report outcomes of endoscopic interventions; and educate physicians and patients about gastrointestinal endoscopy. VideoGIE serves the educational needs of endoscopists in training as well as advanced endoscopists, endoscopy staff and industry, and patients. VideoGIE brings video commentaries from experts, legends, committees, and leadership of the society. Careful adherence to submission guidelines will avoid unnecessary delays, as incomplete submissions may be returned to the authors before initiation of the peer review process.