Department of Gastroenterology, Peking University Third Hospital, Beijing, China.
Eur J Clin Invest. 2021 Mar;51(3):e13408. doi: 10.1111/eci.13408. Epub 2020 Sep 22.
Endoscopic sphincterotomy (EST) can destroy sphincter of Oddi (SO) structure and function. The purpose of this study was to assess the feasibility of endoscopic endoclip papilloplasty (EEPP) in restoring SO function after EST.
Seven 26-week-old domestic pigs were divided into control and EEPP groups. Necropsy and haematoxylin-eosin staining plus anti-α-smooth muscle actin (α-SMA) staining of papilla and sphincter of Oddi manometry (SOM) were conducted in animals at three independent time points.
EST and EEPP were safely performed in all 7 pigs without serious adverse events. For primary outcome, compared to the controls, EEPP generated smaller dilation and less inflammation. Fibrous repair of the papilla was observed at 24 weeks after EEPP. For secondary outcome, in the control group, SO basal pressure (17.25 ± 18.14 to 5.50 ± 0.71 mmHg), SO contraction amplitude (46.00 ± 19.20 to 34.50 ± 48.79 mmHg), peak (4.50 ± 4.04 to 1.50 ± 2.12) and frequency (3.05 ± 3.29 to 1.41 ± 2.19/min) were reduced after EST. Further reductions to almost 0 of these SOM parameters were observed 3 weeks later, including common bile duct pressure and SO contraction period. In contrast, in the EEPP group, these manometric data were recovered to pre-EST levels, including CBD pressure (11.5 ± 7.31 vs 11 ± 2.16 mmHg), SO pressure (17.50 ± 17.75 vs 18.20 ± 21.39 mmHg) and SO contraction amplitude (53.67 ± 21.54 vs 60.00 ± 36.08 mmHg). However, no significant differences were observed between control and EEPP groups by Student t test.
In this porcine study, EEPP accelerated and improved papillary healing after EST, further preserved SO function.
内镜下括约肌切开术（EST）可破坏 Oddi 括约肌（SO）的结构和功能。本研究旨在评估内镜下夹闭乳头成形术（EEPP）在 EST 后恢复 SO 功能的可行性。
将 7 只 26 周龄的家猪分为对照组和 EEPP 组。在三个独立的时间点对动物进行尸检和苏木精-伊红染色加抗α-平滑肌肌动蛋白（α-SMA）染色，以及乳头和 Oddi 括约肌测压（SOM）。
所有 7 只猪均安全地进行了 EST 和 EEPP，无严重不良事件。主要结果显示，与对照组相比，EEPP 导致的乳头扩张较小，炎症较轻。EEPP 后 24 周观察到乳头的纤维修复。次要结果显示，在对照组中，SO 基础压（17.25±18.14 至 5.50±0.71mmHg）、SO 收缩幅度（46.00±19.20 至 34.50±48.79mmHg）、峰值（4.50±4.04 至 1.50±2.12mmHg）和频率（3.05±3.29 至 1.41±2.19/min）在 EST 后降低。进一步降低至接近 0 的 SOM 参数在 3 周后观察到，包括胆总管压力和 SO 收缩期。相比之下，在 EEPP 组中，这些压力计数据恢复到 EST 前的水平，包括 CBD 压力（11.5±7.31 与 11±2.16mmHg）、SO 压力（17.50±17.75 与 18.20±21.39mmHg）和 SO 收缩幅度（53.67±21.54 与 60.00±36.08mmHg）。然而，通过 Student t 检验，对照组和 EEPP 组之间没有观察到显著差异。
在这项猪研究中，EEPP 加速并改善了 EST 后的乳头愈合，进一步保留了 SO 功能。
