Department of Internal Medicine, Digestive Disease Center and Research Institute, SoonChunHyang University School of Medicine, Bucheon, Korea.
Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Cheonan, Korea.
J Hepatobiliary Pancreat Sci. 2023 Feb;30(2):263-268. doi: 10.1002/jhbp.1180. Epub 2022 Jun 6.
An electrocautery-enhanced delivery system with a lumen-apposing metal stent (LAMS) is available for one-step endoscopic ultrasound-guided transmural drainage (EUS-TD). Bipolar electrosurgery has several potential clinical advantages, including reduced collateral thermal damage, enhanced hemostasis, and no requirement for a return electrode plate. In this study, we compared the technical feasibility and safety of a newly developed bipolar electrocautery-enhanced delivery system with a conventional delivery system for EUS-TD using a LAMS in a porcine model.
Ten days before the study, 12 mini pigs underwent common bile duct ligation for EUS-guided gallbladder drainage. Transenteric puncture was performed, followed by placement of a guidewire. In six pigs, a bipolar electrocautery-enhanced delivery system with LAMS (Hot SPAXUS) was inserted over the guidewire and advanced into the gallbladder, without prior dilation of the tract, by applying a bipolar cut current. In the remaining six pigs, a conventional delivery system with LAMS (Cold SPAXUS) was inserted after tract dilatation using a cystotome. The stent was removed after 4 weeks.
In all pigs, the stent was successfully inserted and deployed in the gallbladder without adverse events. The mean procedure time of EUS-TD was significantly lower in the Hot SPAXUS group than that of the Cold SPAXUS group (mean ± standard deviation: 188.7 ± 5.2 vs 449.5 ± 97.5 s, P = .0019). Stent migration was not observed, and all stents were removed successfully.
Endoscopic ultrasound-guided transmural drainage using a bipolar electrocautery-enhanced LAMS is feasible for reducing the procedure time while maintaining the high success rate and safety of conventional LAMS.
一种带有 lumen-apposing 金属支架（LAMS）的电灼增强输送系统可用于一步式内镜超声引导经壁引流（EUS-TD）。双极电外科具有减少热损伤、增强止血和无需返回电极板等潜在的临床优势。在这项研究中，我们比较了一种新开发的双极电灼增强输送系统与传统输送系统在猪模型中使用 LAMS 进行 EUS-TD 的技术可行性和安全性。
在研究前 10 天，12 头迷你猪接受了胆总管结扎以进行 EUS 引导的胆囊引流。经肠壁穿刺，然后放置导丝。在 6 头猪中，将带有 LAMS 的双极电灼增强输送系统（Hot SPAXUS）在导丝上插入并推进胆囊，而无需事先扩张通道，通过施加双极切割电流。在其余 6 头猪中，在使用膀胱切开刀扩张通道后插入带有 LAMS 的传统输送系统（Cold SPAXUS）。4 周后取出支架。
所有猪的支架均成功插入并在胆囊内展开，无不良事件发生。Hot SPAXUS 组的 EUS-TD 平均手术时间明显短于 Cold SPAXUS 组（平均±标准差：188.7±5.2 与 449.5±97.5 s，P=0.0019）。未观察到支架迁移，所有支架均成功取出。
使用双极电灼增强 LAMS 的内镜超声引导经壁引流可减少手术时间，同时保持传统 LAMS 的高成功率和安全性。
