Feasibility and safety of endoscopic cryoablation at the duodenal papilla: Porcine model  

作　　者：Dennis Yang Mary K Reinhard Mihir S Wagh 

机构地区：[1]Division of Gastroenterology, University of Florida [2]Animal Care Services, Infectious Disease and Pathology, University of Florida

出　　处：《World Journal of Gastrointestinal Endoscopy》2015年第7期728-735,共8页世界胃肠内镜杂志（英文版）（电子版）

摘　　要：AIM: To assess the feasibility and safety of liquid nitrogen spray cryoablation at the duodenal papilla in a porcine model. METHODS: This prospective study protocol was approved by the University of Florida Institutional Animal Care and Use Committee. Six pigs underwent liquid nitrogen spray cryotherapy at the duodenal papilla. Freeze time of 20-s was applied per cycle(4 cycles/session). Survival animals(n = 4) were monitored for adverse events. Hemoglobin, white blood count, liver tests, and lipase were obtained at baseline and post-treatment. EGD was performed on day#7 to evaluate the papilla and for histology. All animals were euthanized and necropsy was performed at the end of the one-week survival period. Feasibility was defined as successful placement of the decompression tube in the duodenum, followed by delivery of spray cryotherapy to the duodenal papilla. Safety was determined by monitoring post-treatment blood tests and clinical course. Treatment effect was defined as endoscopic and histologic changes after cryotherapy. This was established by comparing endoscopic and histologic findings from mucosal biopsies prior to cryotherapy and on post-operative day(POD)#7. Full-thickness specimen was obtained post-mortem to assess depth of injury. RESULTS: Spray cryotherapy was feasible and successfully performed in all 6/6(100%) animals. Cryospray with liquid nitrogen(four 20-s freeze-thaw cycles) at the duodenal papilla resulted in white frost formation at and around the target region. The mean proceduraltime was 54.5 min(range 50-58 min). All six animals studied had stable blood pressure, heart rate, and pulse oximetry measurements during the procedure. There were no significant intra-procedural adverse events. There were no significant differences in hemoglobin, white cell count, liver tests or lipase from baseline to post-cryotherapy. Survival animals were monitored daily post-operatively without any clinical ill effects from the cryotherapy. There was no bleeding, infection, or perforation on necropsy. EndAIM： To assess the feasibility and safety of liquidnitrogen spray cryoablation at the duodenal papilla in aporcine model.METHODS： This prospective study protocol wasapproved by the University of Florida Institutional AnimalCare and Use Committee. Six pigs underwent liquidnitrogen spray cryotherapy at the duodenal papilla.Freeze time of 20-s was applied per cycle （4 cycles/session）. Survival animals （n = 4） were monitoredfor adverse events. Hemoglobin, white blood count,liver tests, and lipase were obtained at baseline andpost-treatment. EGD was performed on day#7 toevaluate the papilla and for histology. All animals wereeuthanized and necropsy was performed at the end ofthe one-week survival period. Feasibility was defined assuccessful placement of the decompression tube in theduodenum, followed by delivery of spray cryotherapyto the duodenal papilla. Safety was determined bymonitoring post-treatment blood tests and clinicalcourse. Treatment effect was defined as endoscopicand histologic changes after cryotherapy. This wasestablished by comparing endoscopic and histologicfindings from mucosal biopsies prior to cryotherapy andon post-operative day （POD）#7. Full-thickness specimenwas obtained post-mortem to assess depth of injury.RESULTS： Spray cryotherapy was feasible and successfullyperformed in all 6/6 （100%） animals. Cryospraywith liquid nitrogen （four 20-s freeze-thaw cycles） atthe duodenal papilla resulted in white frost formationat and around the target region. The mean proceduraltime was 54.5 min （range 50-58 min）. All six animalsstudied had stable blood pressure, heart rate, andpulse oximetry measurements during the procedure.There were no significant intra-procedural adverseevents. There were no significant differences inhemoglobin, white cell count, liver tests or lipase frombaseline to post-cryotherapy. Survival animals weremonitored daily post-operatively without any clinical illeffects from the cryotherapy. There was no bleeding,infection, or perforation on necropsy. Endo

关 键 词：Liquid-nitrogen cryotherapy CRYOABLATION Duodenal adenoma AMPULLECTOMY PAPILLECTOMY 

分 类 号：R656.6[医药卫生—外科学]