Initial evaluation of a novel, prototype, forward-viewing echoendoscope in a porcine arterial bleeding model (with video).
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.
Elmunzer
B Joseph
BJ
Division of Gastroenterology, University of Michigan Medical Center, Ann Arbor, Michigan 48109, USA. badihe@umich.edu
Pollack
Michael J
MJ
Trunzo
Joseph A
JA
Schomisch
Steve J
SJ
Wong
Richard C
RC
Faulx
Ashley L
AL
Isenberg
Gerard A
GA
Ponsky
Jeffrey L
JL
Marks
Jeffrey M
JM
Chak
Amitabh
A
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
D014662:Vasoconstrictor Agents; D004837:Epinephrine