Endoscopic Resection Of Pancreatic Tail And Healing Mechanism Of The Wound In A Porcine Study

Objective: At present,the resection of lesion in pancreatic body or tail mainly depends on surgical treatment,but the trauma is large.So it is controversial whether some benign or low-grade malignant lesions of pancreas should receive surgical treatment.With the development of endoscopy,endoscopic resection of some benign or low-grade malignant lesions in pancreatic body or tail may be a promising way,which may reduce the trauma,the incidence of complications,the hospitalization,and financial burden of patients.Although purely endoscopic pancreatectomy has made some progress,there are still some debates about the feasibility and safety of the clinical application of the technique.The purpose of this study is to verify the feasibility and safety,as well as the assessment of its complications,of purely endoscopic pancreatectomy in an animal experiment,to provide a theoretical basis for further clinical application and to accumulate operational experience.In addition,we study the healing mechanism of the pancreatic wound after endoscopic resection to provide guidance for later experimental and clinical work.Methods: Purely transgastric endoscopic resections of different-size pancreas were performed in 15 healthy Bama miniature pigs.Technical success rate,the incidence of serious complications,and animal survival were studied.The healing degree of wound were observed by killing animals at different time points.Finally,the expression of transforming growth factor-?1 and smad3 / smad7 in the surgical site was examined by immunohistochemistry and it was compared with HE staining to explore the mechanism of these factors in wound healing of the pancreas.Results: Partial or total resections were successfully performed in two groups.The technical success rate and survival rate of pigs were both 100% in 15 pigs.There were not the death caused by serious infection or hemorrhage.We obtained 12 pancreatic tissues by endoscopic resection.The pancreatic wound was totally closed by metal clips in one group and the wound healed well by forming scar.There were still small amount of pancreatic leak in the other group,but it can be fully wrapped.The level of transforming growth factor-?1 in the wound increased during the inflammatory phase and fibrous hyperplasia phase,and decreased in the scar phase.The expression of smad3 was in the same direction with transforming growth factor-?1,but the expression of smad7 was in opposite direction with transforming growth factor-?1.Conclusions: Purely transgastric endoscopic resection of panceas is an safe,effective and feasible way.Endoscopic resection of partial pancreatic tail is a safe way,but the incidence of pancreatic leak in total pancreatic tail resection was high.The wound closure by metal clips is an effective way,which reduces pancreatic leak and helps to form the scar of the wound.The expression of transforming growth factor-?1 and smad3/samd7 in different phases of pancreatic wound healing is different,which proves that it relates to the progression of wound healing.