Experimental Study Of Endoscopic Ultrasonography-guided Transoral Gallbladder Puncture And Drainage

Background and ObjectiveIn recent years,endoscopic guided gallbladder drainage(EUS-GBD)by the stomach or duodenum has been increasing,and it can be applied to emergency biliary drainage in patients with acute cholecystitis,cholangitis,cholecystic fluid,malignant biliary obstruction and cannot relieve biliary after endoscopic retrograde cholangiopancreatography,but which puncture route is better through stomach or duodenum,no related reports at home and abroad.The purpose of this project:This experiment uses a mini-pig as a model to perform gallbladder puncture and drainage through the gastric antrum or duodenum under the guidance of ultrasound endoscope.To compare the two approaches are selected in terms of operation difficulty,surgical effect,postoperative complications and follow-up Comparison of the effects of bile on the digestive tract mucosa,and the purpose is to provide the animal model basis and experimental data for the choice of the approach of gallbladder puncture and drainage under the endoscopic ultrasonography for the guidance of clinical word.Methods1.The experimental pigs were divided into 2 groups of 4 heads,and the gallbladder puncture and drainage were performed through the gastric antrum and the duodenum under the guidance of ultrasound endoscope.Record the number of experimental piglets with complete success,operation time,and operation steps.2.Laparoscopic observation of the entire process of transgastric and duodenal gallbladder gallbladder drainage guided by endoscopic ultrasound,and adjuvant treatment if necessary.3.Laparoscopy was performed again on the 10th day after surgery to observe whether the stent was displaced,the stent was blocked,and the omentum was covered at the anastomosis.4.The experimental animals were sacrificed 10 days after the modeling,and the anastomosis was generally observed.The anastomosis and gastric mucosa were observed for histological changes.Results1.Comparison of the success rates of the two groups:3 pigs in each group of the gastric antrum and the duodenal bulb group were completely successful,and the operation success rate in both groups was 75%.2.Comparison of operation time between the two groups:the average operation time in the transgastric sinus group(21.67min)was shorter than that in the bulbous group(26.67min)in the duodenal group(P<0.05).3.Comparison of bile reflux on gastric mucosal injury on the 10th day after operation:the total score of gastric mucosal injury pathological score(8.33 points)was higher than that of the transduodenal group(6.33 points)(P<0.05).4.Comparison of postoperative complications between the two groups:stent displacement,stent occlusion,and bleeding did not occur in the experimental pigs who had successfully performed the operation in the gastric antrum and the duodenal bulb group.ConclusionsIn the animal model of 8 pigs,the success rate of the operation of the gastric antral gallbladder puncture group and the duodenal bulb gallbladder puncture group under ultrasound-guided endoscopy was roughly the same.The operation time in the duodenum puncture group was slightly longer,and there was a statistical difference,but the bile reflux in the duodenum puncture group on the 10th day after surgery had less damage to the gastric mucosa and there was a statistical difference.The duodenal bulb puncture group had an advantage over the antral gallbladder drainage.