Gastric acid secretion and gastrin release during continuous vagal neuromonitoring in thyroid surgery.
PURPOSE
The vagus nerve (VN) has essential regulatory roles in the gastric acid secretion and gastrin release. Continuous intraoperative neuromonitoring (CIONM) via VN stimulation is a promising technique in thyroid surgery because it potentially avoids injury to the recurrent laryngeal nerve. However, no studies have investigated changes in gastric acid secretion and gastrin release during CIONM.


METHOD
This prospective study of 58 thyroid surgery patients compared gastric acid and serum gastrin at five time points: (1) before skin incision, (2) after baseline calibration of CIONM probe, (3) +20 min from baseline, (4) before probe removal, and (5) after extubation. Patients were excluded if they had any history of using tobacco, acid suppression medications, or drugs that affect gastric motility. Patients were also excluded if they had any history of gastroesophageal reflux symptoms, gastroesophageal reflux disease, peptic ulcer disease, helicobacter pylori infection, or chronic kidney disease.


RESULTS
Non significant differences in mean gastric pH values were observed at all time points, i.e., (1) before skin incision (2.2 ± 0.2; p = 0.50), (2) after baseline calibration of CIONM probe (2.0 ± 0.8; p = 0.62), (3) +20 min from baseline (2.5 ± 0.5; p = 0.24), (4) before probe removal (2.9 ± 0.9; p = 0.52), and (5) after extubation (2.6 ± 1.0; p = 0.60). Comparisons of pH monitoring parameters revealed no significant differences in age, gender, side of CIONM (left vs. right), sequence of CIONM, or duration of CIONM. Gastrin values were normal in sequential determinations and did not significantly differ at any time points.


CONCLUSIONS
CIONM performed via VN stimulation during total thyroidectomy in healthy patients does not influence gastrin secretion and gastric pH.
['Xiaoli|Liu|L|', 'Wu|Che-Wei|CW|', 'Kim|Hoon Yub|HY|', 'Tian|Wen|W|', 'Chiang|Feng-Yu|FY|', 'Liu|Renbin|R|', 'Anuwong|Angkoon|A|', 'Randolph|Gregory W|GW|', 'Dionigi|Gianlorenzo|G|', 'Lavazza|Matteo|M|']
D000293:Adolescent D000328:Adult D000368:Aged D005260:Female D005744:Gastric Acid D005745:Gastric Acidity Determination D005755:Gastrins D006801:Humans D008297:Male D008875:Middle Aged D016343:Monitoring, Intraoperative D011446:Prospective Studies D013959:Thyroid Diseases D013965:Thyroidectomy D014630:Vagus Nerve D055536:Vagus Nerve Stimulation D055815:Young Adult
Gastric acid Gastrin release Thyroid surgery C-IONM Vagal nerve