Seok Jeong, MD from the Digestive Disease Center at the Department of Internal Medicine at Inha University School of Medicine in Incheon, Korea shares this New Methods article titled “Development of a swine bile duct dilation model using endoclips or a detachable snare under cap-assisted endoscopy” from the August issue.
In this paper, we introduce 2 endoscopic methods which are able to make the bile duct dilation in a swine model. First is endoclipping of the major duodenal papilla (MDP) and the other is closure of the MDP using a detachable snare. We occluded the MDP with these 2 devices and estimated the efficacy of bile duct dilation in swine.
Bile duct dilation models are considered for training of endoscopic biliary intervention and preclinical testing of newly developed biliary devices. Surgical method has been mainly used to produce large animal models of biliary obstruction until now. However, it requires complicated preparation and postoperative care, for example, analgesics, antibiotics, and wound care. Furthermore, without surgical skills, researchers cannot use this method, which also often leads to the death of the animal. Therefore, it is important to develop the method that can make the bile duct obstruction model convenient and safe.
Figure 2. Cholangiograms of the swine biliary dilation model. A, Preclipping of the duodenal major papilla. B, Preclosure of the duodenal major papilla with a detachable snare. C, Postclipping and, D, postclosure with a detachable snare. Increases in biliary tree diameters were observed at 2 weeks after the endoscopic procedures when A was compared with C, and B was compared with D. The detachable snare tended to be more effective than endoclips based on comparisons of the degrees of dilation achieved.
Both endoscopic procedures appear to be comparable with surgical procedures in terms of producing bile duct dilation. In addition, both were potent also with regard to safety. On the result of comparing 2 devices, a detachable snare is more appropriate than endoclips as a device for bile duct dilation. We expected that these models would be useful for training ERCP and EUS-guided bile duct drainage. Other studies will be proceeded to estimate the actual role of these models.
There could be concerns about adverse events associated with complete papilla obstruction or dropout of the papilla by the detachable snare. However, adverse events and mortality were not seen in all animals tested with snare ligation. This may be because the complete papillary closure was transient, the dropout process of the papilla occurred over several days, and the wound healing of the cutting portion was developed with formation of granulation tissue and fibrosis.
Read the abstract for this article here.
The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.