Successful gastric freezing designed to achieve protracted periods of achlorhydria depends upon the attainment of uniform mucosal-temperature depression over the period of perfusion, an objective regularly achieved on freezing the isolated canine gastric pouch and the intact rodent stomach. This aim is facilitated by the use of four balloon-mucosal interface thermocouples, high collant flow rates, uniform coolant dispersion, perfusion with a nontoxic coolant, and rewarming of the stomach on conclusion of the procedure. Maintenance of balloon-mucosal interface temperatures in the range of -10 C to -11 C for six to seven minutes is optimal but not often registered on all thermocouples. Up to Jan 1, 1966, a total of 698 patients with manifestations of peptic ulcer and 10 patients with esophageal varices had undergone 1,021 episodes of freezing without hospital mortality. Postfreeze bleeding or gastric ulcer or both occurred in 7.5%. Since institution of rapid postfreeze gastric rewarming no complications have been observed. Almost uniform initial relief of pain and a high incidence of ulcer-crater healing were observed. Of those patients undergoing gastric freezing more than 24 months ago, 40% were either asymptomatic or experienced only minimal symptoms.Pursuit of the study of profound gastric hypo¬ thermia came about as a consequence of having observed that patients subjected to prolonged gas¬ tric cooling for hemorrhage volunteered the infor¬ mation that their ulcer pain had been relieved. This suggestion prompted assessment of the influence of freezing upon isolated canine gastric pouches (Heidenhain). Protracted periods of achlorhydria of such pouches to conventional stimulants of gastric secretion, following freezing, led to at¬ tempts to elaborate a safe and practical method of "freezing" the dog's stomach, a technique subse¬ quently subjected to trial in a number of patients with duodenal ulcer who were candidates for sur¬ gery. Again, marked relief of pain was noted, an observation confirmed by many observers who have subjected gastric freezing to clinical trial. Addi¬ tionally, disappearance of demonstrated ulcer craters was a frequent sequel.
The Current ProblemExtensive trial in many hands including ours has served to indicate that what can be quite regu¬ larly achieved in the isolated canine gastric pouch following freezing is an extremely difficult task in the intact stomach of both dog and man. This cir¬ cumstance derives from a number of factors, in¬ cluding uneven balloon-mucosal apposition, unequal insulating effects of surrounding viscera, and nonuniform dispersion of coolant-all of which items add up to this: failure to achieve uniform mucosaltemperature depression over the period of the freeze. This handicap will have to be overcome before more durable periods of symptomatic relief and longer periods of secretory depression can be expected to attend freezing of the intact stomach of either dog or man. Currently, techniques of freezing the in¬ tact stomach of dog and man are followed by se¬ creto...
