title: Initial evaluation of a novel, prototype, forward-viewing echoendoscope in a porcine arterial bleeding model (with video).
abstract: 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.
  
  
  METHODS
  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.
  
  
  METHODS
  Animal research facility.
  
  
  METHODS
  The prototype endoscope was used to image submucosal arterial flow. EUS guidance was then used to deliver endoscopic hemostatic therapy and assess treatment adequacy.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  Acute animal model.
  
  
  CONCLUSIONS
  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.affiliation: Division of Gastroenterology, University of Michigan Medical Center, Ann Arbor, Michigan 48109, USA. badihe@umich.edu
authors.forename: B Joseph
authors.initials: BJ
authors.lastname: Elmunzer
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Pollack
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Trunzo
authors.forename: Steve J
authors.initials: SJ
authors.lastname: Schomisch
authors.forename: Richard C
authors.initials: RC
authors.lastname: Wong
authors.forename: Ashley L
authors.initials: AL
authors.lastname: Faulx
authors.forename: Gerard A
authors.initials: GA
authors.lastname: Isenberg
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Ponsky
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Marks
authors.forename: Amitabh
authors.initials: A
authors.lastname: Chak
mesh_terms: D000818:Animals; D016477:Artifacts; D004195:Disease Models, Animal; D004564:Electrocoagulation / Q000295:instrumentation; D019160:Endosonography / Q000295:instrumentation*; D004837:Epinephrine / Q000008:administration & dosage; D004867:Equipment Design; D005753:Gastric Mucosa / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology; D024405:Gastroepiploic Artery / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D006488:Hemostasis, Surgical / Q000295:instrumentation*; D010438:Peptic Ulcer Hemorrhage / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D013552:Swine; D018615:Ultrasonography, Doppler, Color / Q000295:instrumentation*; D018084:Ultrasonography, Interventional / Q000295:instrumentation*; D014662:Vasoconstrictor Agents / Q000008:administration & dosage
chemical_list: D014662:Vasoconstrictor Agents; D004837:Epinephrine