| Part I: Experimental study of endoscopic ultrasound-guided retractable puncture anchor gastrointestinal anastomosisOBJECTIVE: To evaluate the safety and efficacy of endoscopic ultrasound-guided retractable puncture anchor(RPAT)gastrointestinal anastomosis.Methodology: Twelve 4-month-old Bama mini-pigs weighing 15 to 20 kg were randomly divided into experiment group(n =6)and control groups(n = 6).Animals in the experiment group underwent endoscopic ultrasound-guided retractable puncture anchor(RPAT)gastrointestinal anastomosis,whereas those in the control group under Endoscopic ultrasound guided direct gastrointestinal anastomosis(EUS-GE).all the animals experienced EUS-GE which a fully covered metal stent is placed between the stomach and the intestine.Four weeks later,the pig was anesthetized and the standard gastroscope was advanced into the intestine through the previously created fistula.Pigs were euthanized four weeks after EUS-GE.RESULTS: During the operation,endoscopic ultrasound-guided recoverable puncture anchor traction(RPAT)gastrointestinal anastomosis,in which 6 cases of intestinal canal were completed stent release under ultrasound endoscopic monitoring,6 cases were successfully placed,the success rate was 100%(6 / 6),the average operation time was40.19 ± 1.64 min,no adverse events occurred.In the endoscopic ultrasound-guided direct gastrointestinal anastomosis(EUS-GE)method,only 1 case of the bowel was completed with stent release under the monitoring of ultrasound endoscope,and 4 cases were placed under the ultrasound field during stent placement.The success rate was 83%(5/6),the average operation time was 60.19 ± 2.64 minutes,and no adverse events occurred.Four weeks after EUS-GE,all pigs showed normal feeding behavior and showed no signs of infection.Endoscopic imaging showed that the stent did not fall off within 4 weeks after EUS-GE.The stent was obvious and stable in all animals,and there was no tendency to move down.An autopsy revealed complete adhesion between the intestinal wall and the stomach wall.Conclusion: EUS-GE's retrievable puncture anchor pull method has shown promise as a minimally invasive treatment.We believe that this method can be applied to EUS-GE in the near future,because the retractable puncture anchor pulls the gastrointestinal anastomosis to enhance the safety of EUS-GE during the operation.Part II: Endoscopic ultrasound guided pyloric closed gastrointestinal anastomosis after weight change in animalsOBJECTIVE: To evaluate the effect of endoscopic ultrasound-guided pyloric closed gastrointestinal anastomosis on the weight of experimental animals.Methodology: Sixteen Bama mini pigs(15-20 kg)were randomly divided into an experimental group and a control group.Eight rats in the experimental group underwent gastrointestinal anastomosis under endoscopic ultrasound-guided recoverable anchor traction(RPAT),and eight in the control group were fed with normal diet.After 8animals in the experimental group received pylorus closure,a fully covered anastomotic metal stent was placed between the stomach and jejunum.A fully covered metal stent is placed between the stomach and intestine.Four weeks later,the pig was anesthetized to observe the closure of the pylorus with a gastroscope,and the standard gastroscope was pushed into the intestine through the previously created fistula to determine the patency of the stent.After the operation,the weight of the experimental animals and the liver function and blood lipid changes of the animals were observed weekly.Ten weeks after the pylorus was completely closed,the pigs were euthanized.RESULTS: Eight Bama minipigs(15-20 kg)received pylorus closure and successfully performed EUS-GE with no adverse events.8 Bama miniature pigs(15-20 kg)are kept on a normal diet.All pigs showed normal feeding behavior and showed no signs of infection.Endoscopic imaging of the experimental group showed that the stent did not fall off within 4 weeks after EUS-GE,and 2 weeks after surgery,the pylorus was not completely closed,and the endoscope barely passed.At 12 weeks after surgery,the pylorus was completely closed,the endoscope could not pass,food could only pass through the stent,and the weight of 8 animals in the experimental group decreased significantly compared with that before the operation,and the weight of 6 animals in the control group increased.There was no significant difference between the total protein of the 8 experimental groups and the control group,and the change of cholesterol in the 2groups was not statistically significant.Conclusion: After 4 weeks,the pylorus of the experimental group could be completely closed,and the weight of 8 animals decreased significantly compared with that before the operation,and the weight of the 8 animals changed significantly compared with the control group,which was statistically significant.Endoscopic ultrasound-guided pyloric closure anastomosis can reduce body weight.Part III:Clinical study of endoscopic ultrasound guided gastrointestinal anastomosisOBJECTIVE: To evaluate the therapeutic effect of endoscopic ultrasound-guided retractable puncture anchor(RPAT)gastrointestinal anastomosis on diseases such as upper gastrointestinal obstruction and to analyze the safety and efficacy of the treatment.METHODS:Patients with gastrointestinal anastomosis guided by endoscopic ultrasonography in our hospital from June 2016 to December 2018 were enrolled in the study.The operation time of anastomosis,success rate,white blood cell count and reintervention rate was observed.we record the success rate of treatment for oral gastrointestinal anastomosis,symptom relief rate,postoperative complications,average stent retention time,and oral feeding status after surgery.Scaffold displacement.Using SPSS19.0 software,X2 test Fisher's exact probability method and two independent sample rank sum test were used to analyze the data.RESULTS: The average operation time of 12 patients underwent endoscopic gastrointestinal anastomosis was 40.19 ± 1.64 minutes,2 patients had transient fever after operation,2 patients had transient white blood cell elevation after operation,and they all improved after applying antibiotics.There were 0 cases of hemorrhage,0 cases of severe abdominal infection,1 case of stent position change,and 1 case of death.The postoperative follow-up patient's stent retention time can be as long as 6 months,0 cases of postoperative complications,1 case of intervention again,postoperative food remission rate of 100%,benign postoperative survival time,the stent can be maintained for 6 months until removal.Postoperative malignant disease survival time was 2.7 months.During the same period,23 patients underwent successful endoscopic duodenal stent placement.The average operation time was 25 ± 2.30 min.There were 3 cases of transient fever after operation and 3 cases of transient white blood cell elevation after operation.All of them improved after applying antibiotics.There were 0 cases of bleeding,0 cases of severe abdominal infection,and 0 cases of death.Postoperative follow-up patients had the longest stent retention time of up to 6 months.There were 0postoperative complications and 4 cases of intervention again.The postoperative food remission rate was 100%,and the postoperative malignant disease survival time was 3.9months.Conclusion: Endoscopic ultrasound guided puncture anchor traction method is a safe and effective,minimally invasive,simple,easy to operate,wide range of applications can alleviate the treatment of upper gastrointestinal obstruction,and the operation process Safety,improve the quality of life of patients with advanced disease. |
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