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Pang H, Man Q, Min L, Zhang Z, Zhu S, Yang S, Xu Y, Hou H, Zhang S, Li P. Endoscopic ultrasound-guided gallbladder endoscopic mucosal resection: a pilot porcine study. MINIM INVASIV THER 2023; 32:24-32. [PMID: 36576063 DOI: 10.1080/13645706.2022.2153228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Endoscopic ultrasound (EUS)-guided natural orifice transluminal gallbladder polypectomy provides a minimally invasive alternative to cholecystectomy. The study aimed to investigate the feasibility and safety of protocol for gallbladder endoscopic mucosal resection (gEMR) under EUS guidance using a porcine model. MATERIAL AND METHODS Fifteen Bama mini pigs were randomly divided into the control (CG, n = 3) and experimental (EG, n = 12) groups. EUS-guided fine needle aspiration was performed in the CG and used to establish a gallbladder pathway for polyp resection under EUS guidance in the EG. Procedural safety was evaluated using routine blood and biochemical tests, microbial bile cultures, histopathological tests, and enzyme-linked immunosorbent assays for inflammatory adhesion factors. RESULTS EUS-guided metal stents were successfully deployed in all 12 pigs. Two cases of stent displacement occurred postoperatively, and one pig died of infectious peritonitis on the first day after stent implantation. In 11 surviving experimental animals, mature gallbladder paths were formed at 7-14 days after gastro-cholecystostomy, through which gEMR of gallbladder polyps was successfully performed. There were no significant changes in levels of inflammatory and adhesion factors during the postoperative process. CONCLUSIONS EUS-gEMR may be a safe and effective minimally invasive treatment approach for gallbladder polyps.
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Affiliation(s)
- Huifang Pang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, Beijing, China.,Department of Gastroenterology, Digestive Endoscopy Unit, Tongliao City Hospital, Tongliao, China
| | - Quan Man
- Department of General Surgery, Tongliao City Hospital, Tongliao, China
| | - Li Min
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, Beijing, China
| | - Zheng Zhang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, Beijing, China
| | - Shengtao Zhu
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, Beijing, China
| | - Shuyue Yang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, Beijing, China
| | - Yao Xu
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, Beijing, China
| | - Haijun Hou
- Department of Anesthesia, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Shutian Zhang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, Beijing, China
| | - Peng Li
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, Beijing, China
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Ge N, Zhang K, Hu J, Sun S. How to perform EUS-based cholecystolithotomy. Endosc Ultrasound 2020; 9:162-166. [PMID: 32584311 PMCID: PMC7430904 DOI: 10.4103/eus.eus_36_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
EUS-guided gallbladder drainage (EUS-GBD) is gradually emerging as an option for patients with cholecystitis. A stent-bridged endoscopic intervention in the gallbladder (GB) has been proposed. The formation of a fistulous tract after EUS-GBD facilitates the entry of the endoscope inside the GB to perform endoscopic lithotomy and polypectomy, which is an efficient and safe procedure. However, the technical aspects of this procedure in order to optimize the success rate have only been scarcely discussed. This paper discusses the EUS-GBD prepared for per-oral cholecystolithotomy, the stent indwelling time, the procedure, the devices of per-oral cholecystolithotomy and the follow-up. The recently published literature on this topic is also updated in this review.
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Affiliation(s)
- Nan Ge
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Kai Zhang
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Jinlong Hu
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Siyu Sun
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China,Address for correspondence Dr. Siyu Sun, No. 36, Sanhao Street, Shenyang 110004, Liaoning Province, China. E-mail:
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Stanek A, Dohan A, Barkun J, Barkun A, Reinhold C, Valenti D, Cassinotto C, Gallix B. Percutaneous cholecystostomy: A simple bridge to surgery or an alternative option for the management of acute cholecystitis? Am J Surg 2018; 216:595-603. [DOI: 10.1016/j.amjsurg.2018.01.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 12/26/2017] [Accepted: 01/13/2018] [Indexed: 02/01/2023]
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Oliveira ALA, Zorron R, Oliveira FMMDE, Santos MBD, Scheffer JP, Rios M, Antunes F. Transcolonic Perirectal NOTES Access (PNA): A feasibility study with survival in swine model. AN ACAD BRAS CIENC 2018; 89:685-693. [PMID: 28562823 DOI: 10.1590/0001-3765201720160541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 01/23/2017] [Indexed: 12/22/2022] Open
Abstract
Transrectal access still has some unsolved issues such as spatial orientation, infection, access and site closure. This study presents a simple technique to perform transcolonic access with survival in a swine model series. A new technique for NOTES perirectal access to perform retroperitoneoscopy, peritoneoscopy, liver and lymphnode biopsies was performed in 6 pigs, using Totally NOTES technique. The specimens were extracted transanally. The flexible endoscope was inserted through a posterior transmural incision and the retrorectal space. Cultures of bacteria were documented for the retroperitoneal space and intra abdominal cavity after 14 days. Rectal site was closed using non-absorbable sutures. There was no bowel cleansing, nor preoperative fasting. The procedures were performed in 6 pigs through transcolonic natural orifice access using available endoscopic flexible instruments. All animals survived 14 days without complications, and cultures were negative. Histopathologic examination of the rectal closure site showed adequate healing of suture line and no micro abscesses. The results of feasibility and safety of experimental Transcolonic NOTES potentially brings new frontiers and future wider applications for minimally invasive surgery. The treatment of colorectal, abdominal and retroperitoneal diseases through a flexible Perirectal NOTES Access (PNA) is a promising new approach.
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Affiliation(s)
- André L A Oliveira
- Departamento de Cirurgia Veterinária, Universidade Estadual do Norte Fluminense, Campos dos Goytacazes, RJ, Brazil
| | | | | | - Marcelo B Dos Santos
- Departamento de Cirurgia Veterinária, Universidade Estadual do Norte Fluminense, Campos dos Goytacazes, RJ, Brazil
| | - Jussara P Scheffer
- Departamento de Cirurgia Veterinária, Universidade Estadual do Norte Fluminense, Campos dos Goytacazes, RJ, Brazil
| | - Marcelo Rios
- Clínica Veterinária-Gávea, Rio de Janeiro, RJ, Brazil
| | - Fernanda Antunes
- Departamento de Cirurgia Veterinária, Universidade Estadual do Norte Fluminense, Campos dos Goytacazes, RJ, Brazil
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Ge N, Sun S, Sun S, Wang S, Liu X, Wang G. Endoscopic ultrasound-assisted transmural cholecystoduodenostomy or cholecystogastrostomy as a bridge for per-oral cholecystoscopy therapy using double-flanged fully covered metal stent. BMC Gastroenterol 2016; 16:9. [PMID: 26782105 PMCID: PMC4717638 DOI: 10.1186/s12876-016-0420-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Accepted: 01/08/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Laparoscopic cholecystectomy (LC) has become the 'gold standard' for the treatment of symptomatic gallstones. Innovative methods are being introduced, and these procedures include transgastric or transcolonic endoscopic cholecystectomy. However, before clinical implementation, instruments still need modification, and a more convenient treatment is still needed. Moreover, some gallbladders still have good functionality and cholecystectomy may be associated with various complications. The aim of this study was to evaluate the trans-gastrointestinal tract cholecystoscopy technique in the treatment of gallbladder disease without cholecystectomy. METHOD Endoscopic ultrasound (EUS)-guided cholecystoduodenostomy or cholecystogastrostomy with the placement of a double-flanged fully covered metal stent was performed and endoscopic sphincterotomy (EST) was also performed during this procedure for those patients with accompanying common bile duct stones. One or two weeks later the stent was removed and an endoscope was advanced into the gallbladder via the fistula, and cholecystolithotomy or polyp resection was performed. Four weeks later gallbladder was assessed by abdominal ultrasound. RESULTS EUS guided cholecystoduodenostomy (n = 3) or cholecystogastrostomy (n = 4) with double flanged mental stent deployment was successfully performed in all of 7 patients. After the procedure, fistulas had formed in each of the patients and the stents were removed. Endoscopic cholecystolithotomy(7) and polyps resection(2) were successfully performed through the fistulas. Common bile duct stones were also successfully removed in 5 patients. The ultrasound examination of the gallbladder 4 weeks later showed no stones remaining and also showed satisfactory functioning of the gallbladder. CONCLUSION The EUS-guided placement of a novel metal stent is a safe and simple approach for performing an endoscopic cholecystoduodenostomy or cholecystogastrostomy, which can subsequently allow procedures to be performed for treating biliary disease, including cholecystolithotomy.
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Affiliation(s)
- Nan Ge
- Endoscopy Center, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Shenyang, Liaoning Province, 110004, China
| | - Siyu Sun
- Endoscopy Center, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Shenyang, Liaoning Province, 110004, China.
| | - Shiwei Sun
- Anesthesia Department, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Shenyang, Liaoning Province, 110004, China
| | - Sheng Wang
- Endoscopy Center, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Shenyang, Liaoning Province, 110004, China
| | - Xiang Liu
- Endoscopy Center, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Shenyang, Liaoning Province, 110004, China
| | - Guoxin Wang
- Endoscopy Center, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Shenyang, Liaoning Province, 110004, China
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Ge N, Wang S, Wang S, Wang G, Liu X, Guo J, Yang F, Liu W, Sun S. Endoscopic ultrasound-assisted cholecystogastrostomy by a novel fully covered metal stent for the treatment of gallbladder stones. Endosc Ultrasound 2015; 4:152-5. [PMID: 26020052 PMCID: PMC4445175 DOI: 10.4103/2303-9027.156749] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 04/21/2015] [Indexed: 01/11/2023] Open
Abstract
An 85-year-old male patient with common bile duct stones and gallbladder stone was admitted to the hospital. Endoscopic ultrasound (EUS)-guided cholecystogastrostomy and the placement of a novel covered mental stent was performed after the endoscopic sphincter ectomy procedure. Two weeks later the stents were removed, and an endoscope was advanced into the gallbladder via the fistula, and cholecystolithotomy was performed. For weeks later gallbladder was assessed by abdominal ultrasound. EUS-guided cholecystogastrostomy with mental stent deployment was successfully performed. Two weeks after the procedure, the fistulas had formed, and the stent were removed. Endoscopic cholecystolithotomy was successfully performed through the fistula. The ultrasound exam of gallbladder 4 weeks later showed no stone remain and satisfactory function. The EUS-guided placement of a novel metal stent was a safe and simple approach to performing an endoscopic cholecystogastrostomy, which can subsequently allow procedures for treating biliary disease, including cholecystolithotomy.
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Affiliation(s)
- Nan Ge
- Endoscopy Center, Sheng Jing Hospital of China Medical University, Liaoning, China
| | - Shupeng Wang
- Endoscopy Center, Sheng Jing Hospital of China Medical University, Liaoning, China
| | - Sheng Wang
- Endoscopy Center, Sheng Jing Hospital of China Medical University, Liaoning, China
| | - Guoxin Wang
- Endoscopy Center, Sheng Jing Hospital of China Medical University, Liaoning, China
| | - Xiang Liu
- Endoscopy Center, Sheng Jing Hospital of China Medical University, Liaoning, China
| | - Jintao Guo
- Endoscopy Center, Sheng Jing Hospital of China Medical University, Liaoning, China
| | - Fei Yang
- Endoscopy Center, Sheng Jing Hospital of China Medical University, Liaoning, China
| | - Wen Liu
- Endoscopy Center, Sheng Jing Hospital of China Medical University, Liaoning, China
| | - Siyu Sun
- Endoscopy Center, Sheng Jing Hospital of China Medical University, Liaoning, China
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