Hirota Masashi, Miyazaki Yasuhiro, Takahashi Tsuyoshi, Yamasaki Makoto, Takiguchi Shuji, Mori Masaki, Doki Yuichiro, Nakajima Kiyokazu
1Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan 2Division of Collaborative Research for Next Generation Endoscopic Intervention, Center for Advanced Medical Engineering and Informatics, Osaka University, Osaka, Japan.
Dis Colon Rectum. 2014 Sep;57(9):1120-8. doi: 10.1097/DCR.0000000000000190.
Steady pressure automatically controlled endoscopy is a new insufflation concept, achieving a laparoscopy-like steady environment in the upper GI tract, recently reported in the esophagus.
The purpose of this work was to validate the feasibility and safety of steady pressure automatically controlled endoscopy in the lower GI tract and to identify major factors that enable it.
This was a nonsurvival animal study using canine models.
The study was conducted in an academic center.
Canine models were used in this study.
In experiment 1, steady pressure automatically controlled endoscopy was attempted in the cecum with insufflation pressures of 4, 8, and 12 mm Hg. We assessed performance by video review and continuous intracecal pressure monitoring. Next, steady pressure automatically controlled endoscopy was performed for 20 minutes under optimal pressure, 8 mm Hg (n = 10). In experiment 2, steady pressure automatically controlled endoscopy was attempted in the rectum with or without artificial colonic flexure and with either low (8 mm Hg) or high (16 mm Hg) insufflation pressure to assess the effects of anatomic flexure and insufflation pressure on the establishment of steady pressure automatically controlled endoscopy (n = 6).
We measured multipoint intraluminal pressure monitoring in the upstream bowel, as well as cardiopulmonary parameters.
For experiment 1, steady pressure automatically controlled endoscopy in cecum was successful at all of the tested insufflation pressures; 8 mm Hg provided the optimal result. Steady pressure automatically controlled endoscopy was safely performed for 20 minutes at 8 mm Hg without any cardiopulmonary parameter changes or intraluminal pressure elevation in the upstream bowel. For experiment 2, confinement of the steady pressure environment to the rectum was achieved only with the assistance of colonic flexure and at 8 mm Hg insufflation pressure. In other conditions, the insufflated gas extended throughout the entire colon.
This study was limited by being an animal study.
Steady pressure automatically controlled endoscopy is feasible and safe in the lower GI tract under the optimized insufflation pressure and in the presence of anatomical flexure (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A150).
恒压自动控制内镜检查是一种新的充气概念，可在上消化道实现类似腹腔镜检查的稳定环境，最近已在食管中得到报道。
本研究旨在验证恒压自动控制内镜检查在下消化道的可行性和安全性，并确定实现该技术的主要因素。
这是一项使用犬类模型的非存活动物研究。
该研究在一个学术中心进行。
本研究使用犬类模型。
在实验1中，尝试在盲肠进行恒压自动控制内镜检查，充气压力分别为4、8和12 mmHg。我们通过视频回顾和连续的盲肠内压力监测来评估操作效果。接下来，在最佳压力8 mmHg下进行20分钟的恒压自动控制内镜检查（n = 10）。在实验2中，尝试在直肠进行恒压自动控制内镜检查，有无人工结肠弯曲，充气压力为低（8 mmHg）或高（16 mmHg），以评估解剖弯曲和充气压力对恒压自动控制内镜检查建立的影响（n = 6）。
我们测量了上游肠段的多点腔内压力监测以及心肺参数。
对于实验1，在所有测试的充气压力下，盲肠的恒压自动控制内镜检查均成功；8 mmHg提供了最佳结果。在8 mmHg下安全地进行了20分钟的恒压自动控制内镜检查，未出现任何心肺参数变化或上游肠段腔内压力升高。对于实验2，仅在结肠弯曲的辅助下和8 mmHg充气压力下，才能将恒压环境限制在直肠。在其他条件下，注入的气体扩散至整个结肠。
本研究受限于动物研究。
在优化的充气压力和存在解剖弯曲的情况下，恒压自动控制内镜检查在下消化道是可行且安全的（见视频，补充数字内容1，http://links.lww.com/DCR/A150）。
