Document Detail


Initial evaluation of a novel, prototype, forward-viewing echoendoscope in a porcine arterial bleeding model (with video).
MedLine Citation:
PMID:  20630519     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Real-time visualization of submucosal arterial flow at the base of an ulcer might improve endoscopic hemostasis by permitting more accurate assessment of the artery, precise targeting of therapy, and confirmation of vessel ablation.
OBJECTIVE: To evaluate the utility of a novel, forward-viewing echoendoscope in identifying bleeding submucosal arteries, guiding hemostatic therapy, and confirming cessation of flow through treated vessels.
DESIGN: In 7 pigs, a previously described porcine model for peptic ulcer hemorrhage was created by isolating the gastroepiploic and/or short gastric artery and tunneling it into the subserosal space at laparotomy.
SETTING: Animal research facility.
INTERVENTION: The prototype endoscope was used to image submucosal arterial flow. EUS guidance was then used to deliver endoscopic hemostatic therapy and assess treatment adequacy.
MAIN OUTCOME MEASUREMENTS: Identification of the target submucosal artery and successful delivery of EUS-guided endoscopic therapy, evidenced by cessation of Doppler flow through the target vessel.
RESULTS: Tunneled arteries were visualized endosonographically in all 7 cases. EUS-guided submucosal injection of epinephrine was successful in 2 of 2 cases. EUS-guided delivery of thermal hemostatic therapy was successful in 2 of 4 cases. Absence of flow through treated vessels was confirmed in cases in which EUS-guided therapy was successfully delivered.
LIMITATIONS: Acute animal model.
CONCLUSION: Proof of principle experiments in a porcine peptic ulcer hemorrhage model suggest that real-time sonographic imaging of submucosal arteries is feasible with a forward-viewing echoendoscope, and guided hemostatic therapy can be delivered.
Authors:
B Joseph Elmunzer; Michael J Pollack; Joseph A Trunzo; Steve J Schomisch; Richard C Wong; Ashley L Faulx; Gerard A Isenberg; Jeffrey L Ponsky; Jeffrey M Marks; Amitabh Chak
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Publication Detail:
Type:  Journal Article; Video-Audio Media     Date:  2010-07-13
Journal Detail:
Title:  Gastrointestinal endoscopy     Volume:  72     ISSN:  1097-6779     ISO Abbreviation:  Gastrointest. Endosc.     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-08-30     Completed Date:  2011-01-14     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0010505     Medline TA:  Gastrointest Endosc     Country:  United States    
Other Details:
Languages:  eng     Pagination:  611-4     Citation Subset:  IM    
Copyright Information:
Copyright 2010 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.
Affiliation:
Division of Gastroenterology, University of Michigan Medical Center, Ann Arbor, Michigan 48109, USA. badihe@umich.edu
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MeSH Terms
Descriptor/Qualifier:
Animals
Artifacts
Disease Models, Animal*
Electrocoagulation / instrumentation
Endosonography / instrumentation*
Epinephrine / administration & dosage
Equipment Design
Gastric Mucosa / blood supply,  pathology,  ultrasonography
Gastroepiploic Artery / pathology,  surgery,  ultrasonography
Hemostasis, Surgical / instrumentation*
Peptic Ulcer Hemorrhage / pathology,  surgery*,  ultrasonography*
Swine
Ultrasonography, Doppler, Color / instrumentation*
Ultrasonography, Interventional / instrumentation*
Vasoconstrictor Agents / administration & dosage
Chemical
Reg. No./Substance:
0/Vasoconstrictor Agents; 51-43-4/Epinephrine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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