Retrievable puncture anchor traction method for endoscopic ultrasound-guided gastroenterostomy: A porcine study
Retrievable puncture anchor traction method for endoscopic ultrasound-guided gastroenterostomy: A porcine study
复制标题
用于内镜超声引导胃肠造口术的可回收穿刺锚牵引方法：猪研究
DOI：
10.3748/wjg.v26.i25.3603
复制
发表时间：
2020-07-07
影响因子：
4.3
通讯作者：
Sun, Si-Yu
中科院分区：
文献类型：
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作者：
Wang, Guo-Xin;Zhang, Kai;Sun, Si-Yu
背景超声引导下胃肠吻合术(EUS-GE)是治疗胃出口梗阻的另一种方法，但由于肠道的高度流动性和可遮盖性，它对内窥镜医生来说是一项具有挑战性的技术。因此，这项技术需要高超的技能。为了改进EUS-GE，我们为EUS-GE开发了一种可回收的穿刺式锚定牵引(RPAT)装置，以解决肠道帐篷的问题。目的通过动物模型评价RPAT辅助EUS-GE的可行性。方法6头巴马小型猪，体重15~20 kg，行RPAT辅助EUS-GE手术。注意确保动物经历的疼痛和不适降至最低。在手术前两天，这些动物被限制在流质饮食中。手术前一天不允许口服。使用RPAT辅助的EUS-GE方法在胃和肠之间放置一个完全覆盖的金属支架。确定了动物的感染情况。手术四周后，通过先前创建的瘘管将标准胃镜插入猪的肠道，以检查麻醉下支架的状态。这头猪在检查后被实施了安乐死。结果RPAT辅助的EUS-GE方法可在所有6只动物中无并发症地放置支架。所有的猪在手术后的几个小时内都能耐受正常的饮食。在RPAT辅助EUS-GE后对动物进行了四周的监测，在此期间所有动物都表现出正常的进食行为，没有观察到感染的迹象。在RPAT辅助EUS-GE治疗四周后进行的内窥镜成像显示，支架在所有动物体内保持开放和稳定。在任何情况下都没有观察到组织过度生长或向内生长。每只动物都有一个成熟的瘘管，支架被取出时没有明显出血。对所有六头猪的尸检显示，肠道和胃壁之间完全粘连。结论RPAT方法有助于降低肠道活动度。因此，RPAT辅助的EUS-GE方法是一种微创的治疗方式。
BACKGROUND Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is an alternative method for the surgical treatment of gastric outlet obstruction, but it is regarded as a challenging technique for endoscopists as the bowel is highly mobile and can tent away. Thus, the technique requires superb skill. In order to improve EUS-GE, we have developed a retrievable puncture anchor traction (RPAT) device for EUS-GE to address the issue of bowel tenting. AIM To evaluate the feasibility of RPAT-assisted EUS-GE using an animal model. METHODS Six Bama mini pigs each weighing between 15 and 20 kg underwent the RPAT-assisted EUS-GE procedure. Care was taken to ensure that the animals experienced minimal pain and discomfort. Two days prior to the procedure the animals were limited to a liquid diet. No oral intake was allowed on the day before the procedure. A fully covered metal stent was placed between the stomach and the intestine using the RPAT-assisted EUS-GE method. Infection in the animals was determined. Four weeks after the procedure, a standard gastroscope was inserted into the pig’s intestine through a previously created fistula in order to check the status of the stents under anesthesia. The pig was euthanized after examination. RESULTS The RPAT-assisted EUS-GE method allowed placement of the stents with no complications in all six animals. All the pigs tolerated a regular diet within hours of the procedure. The animals were monitored for four weeks after the RPAT-assisted EUS-GE, during which time all of the animals exhibited normal eating behavior and no signs of infection were observed. Endoscopic imaging performed four weeks after the RPAT-assisted EUS-GE showed that the stents remained patent and stable in all the animals. No tissue overgrowth or ingrowth was observed in any case. Each animal had a mature fistula, and the stents were removed without significant bleeding. Autopsies of all six pigs revealed complete adhesion between the intestine and the stomach wall. CONCLUSION The RPAT method helps reduce mobility of the bowel. Therefore, the RPAT-assisted EUS-GE method is a minimally invasive treatment modality.