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The formation process and mechanism of gastrointestinal anastomosis after retrieval anchor-assisted endoscopic ultrasound-guided gastroenterostomy: a preclinical study

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Abstract

Background and aims

Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is a promising method of treating gastric outlet obstruction. However, no study has investigated gastrointestinal anastomosis formation after EUS-GE. We aimed to evaluate the formation of gastrointestinal anastomosis after EUS-GE in a porcine model.

Methods

Retrieval anchor-assisted EUS-GE was performed on 15 Bama mini pigs. Five pigs each were randomly euthanized 3, 7, and 14 days postoperatively to evaluate the formation of gastrointestinal anastomosis and measure the anastomotic distance. The expression of transforming growth factor-β1(TGF-β1) and Smad3 in the anastomosis site were examined by immunohistochemistry.

Results

EUS-GE was successfully performed in all 15 pigs. The mean procedure time was 29.2 ± 6.0 (range 18–40) minutes. The anastomotic distance was 34.0 ± 3.6 cm in 14 pigs. The site of gastroenterostomy of one pig was at the ileum. For pigs euthanized 3 days postoperatively, the structure was mechanically maintained by a stent. For pigs euthanized 7 or 14 days postoperatively, the stomach and small intestine were anastomosed to form a stable structure. The level of TGF-β1 and Smad3 in the anastomosis site gradually increased from 3 to 14 days after EUS-GE. TGF-β1 and Smad3 expression had a significant difference between 3 days, 7 days, and 14 days after EUS-GE (P < 0.05).

Conclusions

For EUS-GE, the stomach and small intestine were initially linked together mechanically and spontaneously anastomosed to form a stable structure 7 days postoperatively. TGF-β1 and Smad3 play an important role in the formation of a stable structure of gastrointestinal anastomosis.

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Acknowledgements

This study was supported by National Key Research and Development Project of China to Siyu Sun (Grant No. 2017YFC0109803), University innovation team and innovative talent support program of Liaoning province(Grant No. LR2019073) and 345 talent project of Jinlong Hu.

Funding

Funding was provided by 345 Talent Project, National Key Research and Development Project (2017YFC0109803), and University Innovation Team and Innovative Talent Support Program of Liaoning Province (LR2019073).

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Author notes

  1. Jinlong Hu and Guoxin Wang contributed equally to this manuscript.

Authors and Affiliations

  1. Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, 110004, China

    Jinlong Hu, Guoxin Wang, Haixin Gao, Shiyun Sheng & Siyu Sun

Authors
  1. Jinlong Hu
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  2. Guoxin Wang
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  3. Haixin Gao
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  4. Shiyun Sheng
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  5. Siyu Sun
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Contributions

JH drafted the manuscript. JH, GW, HG and SS performed the study. SS designed the study.

Corresponding author

Correspondence to Siyu Sun.

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Disclosures

Siyu Sun is the consultant of Vedkang Medical Science and Technology company and Microtech Technology company. Jinlong Hu, Guoxin Wang, Haixin Gao and Shiyun Sheng have no conflicts of interest to disclose.

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Hu, J., Wang, G., Gao, H. et al. The formation process and mechanism of gastrointestinal anastomosis after retrieval anchor-assisted endoscopic ultrasound-guided gastroenterostomy: a preclinical study. Surg Endosc 37, 2043–2049 (2023). https://doi.org/10.1007/s00464-022-09565-4

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  • DOI: https://doi.org/10.1007/s00464-022-09565-4

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