Introduction: Gastroparesis, or delayed gastric emptying, can be diagnosed with gastric emptying
scintigraphy. Manometric studies of patients with gastroparesis show increased pyloric
tone (pylorospasm). Among the recent endoscopic therapies for pylorospasm is peroral
endoscopic pylorotomy (POP). In this study, we explored the effect of POP on gastric
emptying in healthy pigs.
Material and methods: Four mini-pigs underwent POP following general anaesthesia. The mucosal entrance
was situated 5 cm above the pylorus. POP was performed through a submucosal tunnel
dissection. The duration of gastric emptying was assessed by scintigraphy before and
after the procedure. The pigs were then euthanised for necropsy and pathologic assessment
of the pylorus.
Results: The mean duration of the procedure was 55 (± 4 SD) min. All surgeries were performed
in their entirety with 100 % feasibility. There were no cases of bleeding. The one
case of perforation had no clinical significance. The duration of gastric emptying
was 2.22-fold shorter after POP compared with before POP (T½ post-POP = 84.5 [± 35.7 SD] min vs. T½ pre-POP = 188.4 [± 87.3 SD] min; P = 0.029). In agreement with the endoscopic observations, sectioning of the pyloric
muscle in each pig was histologically complete.
Conclusion: The efficacy of the procedure provides indirect proof of the involvement of the pyloric
ring in delayed gastric emptying and suggests new therapies for patients with gastroparesis.
Our protocol combining gastric emptying scintigraphy and POP validated the use of
anaesthetised mini-pigs as a learning and training model for POP or other endoscopic/surgical
procedures related to gastric emptying.
