Etchepare Nicolas, Bregeon Jérémy, Quénéhervé Lucille, Haddara Sami, Touchefeu Yann, Neunlist Michel, Coron Emmanuel
Institut des Maladies de l'Appareil Digestif, Hôtel Dieu, Centre Hospitalier Universitaire, Nantes, France.
INSERM U 1235 - TENS, Université de Nantes, Faculté de Médecine, Nantes, France.
Endosc Int Open. 2017 Oct;5(10):E1014-E1019. doi: 10.1055/s-0043-115383. Epub 2017 Oct 10.
Endoscopic mucosal resection (EMR) is widely performed for the treatment of colorectal polyps. However, the pathophysiological mechanisms of mucosal repair, including in situations at high risk of post-polypectomy bleeding, remain largely unknown. The objective of our study was to develop a porcine model of EMR in the lower gastrointestinal tract to monitor mucosal wound healing over time.
Under general anesthesia, five large wounds were created in the lower gastrointestinal tract at different times, i. e. at day 0, 3, 7, 10, and 14, by multiband EMR, in each of the six pigs in the study. A colorectal resection was performed at day 14 and the animal euthanized. Repeated endoscopic and endomicroscopic examination, and histological analysis were performed.
No complications occurred and all animals reached the study end point. The endoscopic aspect of wound healing evolved into different phases with first a fibrin deposit covering the wounds which then gave way to granulomatous tissue. The size of the wound regressed significantly as early as day 3. Re-epithelialization of the wound started from day 7, and neo-mucosal crypts appeared from day 10. The endomicroscopic analysis described a 'ground glass appearance' from day 3 and irregular crypts from day 10, which was consistent with histological data. Good agreement between macroscopic, endomicroscopic, and histological parameters of mucosal wound healing was observed in vivo.
This study demonstrates for the first time the feasibility of an experimental in vivo porcine model of lower gastrointestinal endoscopic resections to monitor tissue repair. This model might be helpful to document pharmacological approaches for preventing complications of endoscopic procedures performed in humans.
内镜黏膜切除术（EMR）广泛应用于大肠息肉的治疗。然而，黏膜修复的病理生理机制，包括息肉切除术后出血高风险情况，仍知之甚少。我们研究的目的是建立一种猪的下消化道EMR模型，以监测黏膜伤口随时间的愈合情况。
在全身麻醉下，对研究中的6头猪，于不同时间点（即第0、3、7、10和14天）通过多波段EMR在下消化道制造5个大伤口。在第14天进行结肠直肠切除并对动物实施安乐死。进行反复的内镜和内镜显微镜检查以及组织学分析。
未发生并发症，所有动物均达到研究终点。伤口愈合的内镜表现演变为不同阶段，首先是纤维蛋白沉积覆盖伤口，随后被肉芽组织取代。伤口大小早在第3天就显著缩小。伤口的再上皮化从第7天开始，新的黏膜隐窝从第10天出现。内镜显微镜分析显示从第3天起出现“磨砂玻璃外观”，从第10天起出现不规则隐窝，这与组织学数据一致。在体内观察到黏膜伤口愈合的宏观、内镜显微镜和组织学参数之间具有良好的一致性。
本研究首次证明了建立一种用于监测组织修复的猪下消化道内镜切除体内实验模型的可行性。该模型可能有助于记录预防人类内镜手术并发症的药理学方法。
