title: Endoscopic ultrasound-guided transesophageal thoracic duct puncture in a Swine model: a survival study.
abstract: OBJECTIVE
  The study of lymph as a biofluid is lacking because of absence of a safe site and technique for lymph acquisition. Injury to the thoracic duct during surgery is known to cause chylothorax. The aim of this interventional study was to puncture the thoracic duct under endoscopic ultrasound (EUS) guidance and observe for complications in a swine model.
  
  
  METHODS
  Three female Yorkshire pigs underwent EUS. The thoracic duct was identified by the previously described technique, punctured, and confirmed with a lymphangiogram. Postoperatively, animals were fed and monitored closely for any complications or signs of abnormal behavior indicating pain and/or disease. The animals were euthanized at 1 week, and necropsy was performed per protocol. Main outcome measurements included complications (chylothorax, mediastinitis, perforation, and hemorrhage) during the post-EUS-guided thoracic duct puncture period.
  
  
  RESULTS
  No animals developed any complications during the survival period. The thoracic duct was identified and punctured in all animals. A lymphangiogram was additionally obtained to confirm ductal access. No chylothorax, mediastinitis, hematoma, abscess, or fistula formation was identified in any animal on necropsy.
  
  
  CONCLUSIONS
  EUS-guided transesophageal thoracic duct puncture is safe as demonstrated by this survival study.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University/Sinai Hospital Program in Internal Medicine, Baltimore, MD 21215, USA. girotra.mohit@gmail.com
authors.forename: Mohit
authors.initials: M
authors.lastname: Girotra
authors.forename: John D
authors.initials: JD
authors.lastname: Horwhat
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Settle
authors.forename: Vinod K
authors.initials: VK
authors.lastname: Parasher
mesh_terms: D000818:Animals; D002916:Chylothorax / Q000000981:diagnostic imaging / Q000209:etiology; D019160:Endosonography / Q000379:methods; D005260:Female; D011677:Punctures; D013552:Swine; D013897:Thoracic Duct / Q000000981:diagnostic imaging / Q000601:surgery*; D018084:Ultrasonography, Interventional