title: A Newly Designed Enterocutaneous Esophageal Fistula Model in the Pig.
abstract: Background Fistulas after esophagectomy are a significant cause of morbidity and mortality. Several endoscopic treatments have been attempted, with varying success. An experimental model that could validate new approaches such as cellular therapies is highly desirable. The aim of this study was to create a chronic esophageal enterocutaneous fistula model in order to study future experimental treatment options. Methods Eight pigs (six 35-kg young German and two 50-kg adult Yucatan pigs) were used. Through a left and right cervicotomy, under endoscopic view, 1 (group A, n = 6) or 2 (group B, n = 7) plastic catheters were introduced into the esophagus 30 cm from the dental arches bilaterally and left in place for 1 month. Radiologic and endoscopic fistula tract evaluations were performed at postoperative day (POD; 30) and at sacrifice (POD 45). Results Three fistulas were excluded from the study because of early (POD 5) dislodgment of the catheter, with complete fistula closure. At catheter removal (POD 30), the external orifice was larger in group B (5.2 ± 1.1 mm vs 2.6 ± 0.4 mm) with more severe inflammation (72% vs 33%). At POD 45, the external orifice was closed in all fistulas in group A and in 1/7 in group B. At necropsy, the fistula tract was still present in all animals. Yucatan pigs showed more complex tracts, with a high level of necrosis and substantial fibrotic infiltration. Conclusions In this article, we show a reproducible, safe, and effective technique to create an esophagocutaneous fistula model in a large experimental animal.
authors.affiliation: Laboratoire Imagerie de l'Angiogénèse, Plateforme d'Imagerie du Petit Animal, INSERM U970, Université Paris Descartes, Paris, France Gastroenterology and Endoscopy Department, Hôpital Européen Georges Pompidou, APHP, Paris, France INSERM U633, Laboratory of Biosurgical Research, Paris, France gabriel.rahmi@egp.aphp.fr.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Rahmi
authors.affiliation: Department of Digestive and Endocrine Surgery, Nouvel Hôpital Civil, Institut de Recherche contre les Cancers de l'Appareil Digestif (IRCAD), Strasbourg, France Minimally Invasive Hybrid Surgical Institute, Strasbourg, France.
authors.forename: Silvana
authors.initials: S
authors.lastname: Perretta
authors.affiliation: Laboratoire Imagerie de l'Angiogénèse, Plateforme d'Imagerie du Petit Animal, INSERM U970, Université Paris Descartes, Paris, France INSERM U633, Laboratory of Biosurgical Research, Paris, France.
authors.forename: Laetitia
authors.initials: L
authors.lastname: Pidial
authors.affiliation: University Hospital of Nice, Nice, France Centre d'Enseignement et de Recherche Chirurgical (CERC), Aix-Marseille University, Marseille, France.
authors.forename: Geoffroy
authors.initials: G
authors.lastname: Vanbiervliet
authors.affiliation: Department of Digestive and Endocrine Surgery, Nouvel Hôpital Civil, Institut de Recherche contre les Cancers de l'Appareil Digestif (IRCAD), Strasbourg, France Minimally Invasive Hybrid Surgical Institute, Strasbourg, France.
authors.forename: Peter
authors.initials: P
authors.lastname: Halvax
authors.affiliation: Department of Digestive and Endocrine Surgery, Nouvel Hôpital Civil, Institut de Recherche contre les Cancers de l'Appareil Digestif (IRCAD), Strasbourg, France Minimally Invasive Hybrid Surgical Institute, Strasbourg, France.
authors.forename: Andras
authors.initials: A
authors.lastname: Legner
authors.affiliation: Department of Pathology, Hôpital Hautepierre, Strasbourg, France.
authors.forename: Veronique
authors.initials: V
authors.lastname: Lindner
authors.affiliation: Centre d'Enseignement et de Recherche Chirurgical (CERC), Aix-Marseille University, Marseille, France Department of Gastroenterology, Hôpital Nord, Assistance Publique Hôpitaux de Marseille, Marseille, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Barthet
authors.affiliation: Department of Digestive and Endocrine Surgery, Nouvel Hôpital Civil, Institut de Recherche contre les Cancers de l'Appareil Digestif (IRCAD), Strasbourg, France Minimally Invasive Hybrid Surgical Institute, Strasbourg, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Dallemagne
authors.affiliation: Gastroenterology and Endoscopy Department, Hôpital Européen Georges Pompidou, APHP, Paris, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Cellier
authors.affiliation: Laboratoire Imagerie de l'Angiogénèse, Plateforme d'Imagerie du Petit Animal, INSERM U970, Université Paris Descartes, Paris, France Gastroenterology and Endoscopy Department, Hôpital Européen Georges Pompidou, APHP, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Clément
mesh_terms: D000818:Animals; D001707:Biopsy, Needle; D017577:Cutaneous Fistula / Q000473:pathology / Q000601:surgery*; D004195:Disease Models, Animal; D004937:Esophageal Fistula / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects* / Q000379:methods; D004945:Esophagoscopy / Q000379:methods*; D007150:Immunohistochemistry; D015203:Reproducibility of Results; D013552:Swine
keywords: digestive fistula; esophagus; porcine model; surgical endoscopy