Department of Gastroenterology, Endoscopic Center, Shengjing Hospital of China Medical University, Shenyang 110001, Liaoning Province, China.
World J Gastroenterol. 2020 Jul 7;26(25):3603-3610. doi: 10.3748/wjg.v26.i25.3603.
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.
To evaluate the feasibility of RPAT-assisted EUS-GE using an animal model.
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.
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.
The RPAT method helps reduce mobility of the bowel. Therefore, the RPAT-assisted EUS-GE method is a minimally invasive treatment modality.
内镜超声引导下胃肠吻合术（EUS-GE）是治疗胃出口梗阻的一种替代手术方法，但由于肠道高度移动且可能会被牵拉，因此对于内镜医生来说，这是一项具有挑战性的技术。因此，该技术需要高超的技能。为了改进 EUS-GE，我们开发了一种可回收穿刺锚定牵引（RPAT）设备用于 EUS-GE，以解决肠道牵拉的问题。
用动物模型评估 RPAT 辅助 EUS-GE 的可行性。
6 只 Bama 小型猪，体重在 15-20kg 之间，均接受 RPAT 辅助 EUS-GE 手术。术中注意使动物的疼痛和不适最小化。手术前 2 天，动物只能摄入液体饮食。手术前一天，动物不得口服。使用 RPAT 辅助 EUS-GE 方法，在胃和肠之间放置全覆膜金属支架。确定动物是否有感染。手术后 4 周，在麻醉状态下，通过之前创建的瘘管将标准胃镜插入猪的肠道，以检查支架的状态。检查后，猪被安乐死。
RPAT 辅助 EUS-GE 方法可在 6 只动物中无并发症地放置支架。所有猪在手术后数小时内即可耐受常规饮食。在 RPAT 辅助 EUS-GE 后 4 周对动物进行监测，在此期间，所有动物均表现出正常的进食行为，未观察到感染迹象。RPAT 辅助 EUS-GE 后 4 周进行的内镜成像显示，所有动物的支架均保持通畅和稳定，无组织过度生长或向内生长。每只动物均有成熟的瘘管，且在无明显出血的情况下取出支架。对所有 6 只猪进行尸检，均发现肠壁与胃壁完全粘连。
RPAT 方法有助于减少肠道的活动度。因此，RPAT 辅助 EUS-GE 方法是一种微创治疗方法。
