Background The pathogenesis of several common gastric motility diseases and functional gastrointestinal disorders remains essentially unexplained. Gastric wall biopsies that include the muscularis propria to evaluate the enteric nervous system, interstitial cells of Cajal and immune cells can provide important insights to our understanding of the etiology of these disorders. Objectives To determine 1. Technical feasibility, reproducibility and safety of performing a full thickness gastric biopsy (FTGB) using a submucosal endoscopy with mucosal flap (SEMF) technique; 2. Technical feasibility, reproducibility and safety of tissue closure using an endoscopic suturing device; 3. Ability to identify myenteric ganglia in resected specimens; 4. Long-term safety. Design Single center, pre-clinical survival study. Setting Animal research laboratory – Developmental Endoscopy Unit. Subjects Twelve domestic pigs. Interventions Animals underwent a SEMF procedure with gastric muscularis propria resection. The resultant offset mucosal entry site was closed using an endoscopic suturing device. Animals were survived for 2 weeks. Main Outcome Measurements 1. Technical feasibility, reproducibility and safety of the procedure 2. Clinical course of the animals 3. Histological and immunochemical evaluation of the resected specimen to determine if myenteric ganglia were present in the sample. Results FTGB was achieved using the SEMF technique in all 12 animals. The offset mucosal entry site was successfully closed using the suturing device in all animals. Mean resected tissue size was 11 mm. Mean total procedure time was 61 mins with 2–4 interrupted sutures placed per animal. Histology showed musclaris propria and serosa confirming full thickness resections in all animals. Myenteric ganglia were visualized in 11/12 animals. The clinical course was uneventful. Repeat endoscopy and necropsy at 2 weeks showed absence of ulceration at either the mucosal entry sites or overlying the more distal muscularis propria resection sites. There was complete healing of the serosa in all animals with minimal single band adhesions in 5/12 animals. Retained sutures were present in 10/12 animals. Limitations Animal experiment. Conclusion FTGB using the SEMF technique and endoscopic suturing device is technically feasible, reproducible and safe. The larger tissue specimens will allow for improved analysis of multiple cell types.

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OBJECTIVESymptomatic cervical spondylosis with or without radiculopathy can ground an active-duty military pilot if left untreated. Surgically treated cervical spondylosis may be a waiverable condition and allow return to flying status, but a waiver is based on expert opinion and not on recent published data. Previous studies on rates of return to active duty status following anterior cervical spine surgery have not differentiated these rates among military specialty occupations. No studies to date have documented the successful return of US military active-duty pilots who have undergone anterior cervical spine surgery with cervical fusion, disc replacement, or a combination of the two. The aim of this study was to identify the rate of return to an active duty flight status among US military pilots who had undergone anterior cervical discectomy and fusion (ACDF) or total disc replacement (TDR) for symptomatic cervical spondylosis.METHODSThe authors performed a single-center retrospective review of all active duty pilots who had undergone either ACDF or TDR at a military hospital between January 2010 and June 2017. Descriptive statistics were calculated for both groups to evaluate demographics with specific attention to preoperative flight stats, days to recommended clearance by neurosurgery, and days to return to active duty flight status.RESULTSAuthors identified a total of 812 cases of anterior cervical surgery performed between January 1, 2010, and June 1, 2017, among active duty, reserves, dependents, and Department of Defense/Veterans Affairs patients. There were 581 ACDFs and 231 TDRs. After screening for military occupation and active duty status, there were a total of 22 active duty pilots, among whom were 4 ACDFs, 17 TDRs, and 2 hybrid constructs. One patient required a second surgery. Six (27.3%) of the 22 pilots were nearing the end of their career and electively retired within a year of surgery. Of the remaining 16 pilots, 11 (68.8%) returned to active duty flying status. The average time to be released by the neurosurgeon was 128 days, and the time to return to flying was 287 days. The average follow-up period was 12.3 months.CONCLUSIONSAdhering to military service-specific waiver guidelines, military pilots may return to active duty flight status after undergoing ACDF or TDR for symptomatic cervical spondylosis.

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