Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, 110004, China.
Surg Endosc. 2023 Mar;37(3):2043-2049. doi: 10.1007/s00464-022-09565-4. Epub 2022 Oct 26.
Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is a promising method of treating gastric outlet obstruction. However, no study has investigated gastrointestinal anastomosis formation after EUS-GE. We aimed to evaluate the formation of gastrointestinal anastomosis after EUS-GE in a porcine model.
Retrieval anchor-assisted EUS-GE was performed on 15 Bama mini pigs. Five pigs each were randomly euthanized 3, 7, and 14 days postoperatively to evaluate the formation of gastrointestinal anastomosis and measure the anastomotic distance. The expression of transforming growth factor-β1(TGF-β1) and Smad3 in the anastomosis site were examined by immunohistochemistry.
EUS-GE was successfully performed in all 15 pigs. The mean procedure time was 29.2 ± 6.0 (range 18-40) minutes. The anastomotic distance was 34.0 ± 3.6 cm in 14 pigs. The site of gastroenterostomy of one pig was at the ileum. For pigs euthanized 3 days postoperatively, the structure was mechanically maintained by a stent. For pigs euthanized 7 or 14 days postoperatively, the stomach and small intestine were anastomosed to form a stable structure. The level of TGF-β1 and Smad3 in the anastomosis site gradually increased from 3 to 14 days after EUS-GE. TGF-β1 and Smad3 expression had a significant difference between 3 days, 7 days, and 14 days after EUS-GE (P < 0.05).
For EUS-GE, the stomach and small intestine were initially linked together mechanically and spontaneously anastomosed to form a stable structure 7 days postoperatively. TGF-β1 and Smad3 play an important role in the formation of a stable structure of gastrointestinal anastomosis.
内镜超声引导下胃造口术（EUS-GE）是治疗胃出口梗阻的一种很有前途的方法。然而，目前尚无研究探讨 EUS-GE 后胃肠吻合口的形成。我们旨在评估 EUS-GE 后在猪模型中胃肠吻合口的形成。
对 15 头巴马小型猪进行了回收锚定辅助 EUS-GE。每组 5 头猪，分别在术后 3、7 和 14 天随机安乐死，以评估胃肠吻合口的形成情况，并测量吻合口距离。通过免疫组织化学检测吻合部位转化生长因子-β1（TGF-β1）和 Smad3 的表达。
15 头猪均成功完成 EUS-GE。平均手术时间为 29.2±6.0（范围 18-40）分钟。14 头猪的吻合口距离为 34.0±3.6cm。一头猪的胃肠吻合部位在回肠。对于术后 3 天安乐死的猪，支架机械性维持吻合口结构。对于术后 7 天或 14 天安乐死的猪，胃和小肠吻合形成稳定的结构。EUS-GE 后 3、7 和 14 天，吻合部位的 TGF-β1 和 Smad3 水平逐渐升高。EUS-GE 后 3 天、7 天和 14 天 TGF-β1 和 Smad3 表达有显著差异（P<0.05）。
对于 EUS-GE，胃和小肠最初通过机械连接在一起，并在术后 7 天自发吻合形成稳定的结构。TGF-β1 和 Smad3 在胃肠吻合稳定结构的形成中发挥重要作用。
