首页|Effect of double-balloon enteroscopy on pancreas: An experimental porcine model
Effect of double-balloon enteroscopy on pancreas: An experimental porcine model
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AIM:To evaluate the effect of double-balloon enteroscopy (DBE) on pancreas histology and levels of pancreatic enzymes.METHODS:Conventional upper gastrointestinal endoscopy was performed on five control pigs.Oral DBE was performed with an EN-450T5 enteroscope on 20 pigs.Two experimental groups (10 pigs each) were defined according to DBE duration:90 min for Group 1 and 140 min for Group 2.During oral insertion,the balloons were not inflated in the descending part of the duodenum to avoid the minor duodenal papilla.Serum amylase,lipase and C-reactive protein (CRP) levels were monitored before the procedure and repeated every 30 min until the exploration was finished,as well as 24 h and 7 d after.After the procedure and for a total of 7 d,the pigs were observed twice a day for signs of decreased activity,irritability,vomiting or anorexia.Gross and microscopic examination of the pancreas was performed on day 7.RESULTS:All animals tolerated DBE without clinical manifestations of acute pancreatitis.Experimental groups had higher levels of enzymes than the control group at 24 h.Throughout the exploration,the amylase levels increased significantly above the baseline 24 h after DBE,although the increase was not statistically significant and did not reach 20％ of the baseline.An increase in lipase and CRP was observed at 24 h after the procedure,although by day 7,all enzymatic levels had returned to baseline.No differences between Groups 1 and 2 were found for any enzyme and sampiing site during and after the procedure.Similarly,no correlation between insertion depth and enzyme levels was observed.Direct in situ and post-removal inspection of the pancreas did not show any evidence of fluid collection,abscesses or hemorrhage.Histological examination of the pancreas from Groups 1 and 2 revealed the existence of focal areas (0.14-0.26 mm2) of ischemic necrosis in 47.4％ of the animals.In the pigs with damaged pancreas,the left lobe (tail) was always affected.However,this only happened in 83.3％ of the samples from the right lobe (head) and in 33.3％ of the samples from the body of the pancreas.Significant differences were found between the left lobe (tail) and the body for the percentage of affected pancreas.Both the size of the lesions and the percentage of affected pancreas were higher in the left pancreatic lobe (tail).The presence of the lesions was not related to the exploration length.CONCLUSION:The increase in pancreatic enzymes after DBE could be related to focal points of pancreatic ischemic necrosis due to mechanical stress.
EndoscopyPancreatitisDouble-balloon enteroscopyExperimental studyPig model
Rafael Latorre、Federico Soria、Octavio López-Albors、Ricardo Sarriá、Francisco Sánchez-Margallo、Pilar Esteban、Fernando Carballo、Enrique Pérez-Cuadrado
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Department of Anatomy and Comparative Pathology, University of Murcia, Campus de Espinardo, 30100 Murcia, Spain
Jesús Usón Minimally Invasive Surgery Center, 10071 Cáceres, Spain
Digestive Service, Virgen de la Arrixaca Hospital, 30120 Murcia, Spain
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PI070712 Project (Instituto de Salud Carlos Ⅲ,Ministerio de Sandiad y Consumo,Spain)BIO-MED 07/08-0019 Project (Consejería de Educación,Ciencia e Investigación de la Región de Murcia,Spain)
NETL
NSTL
万方数据
维普
