ABSTRACT
Objective:To investigate the safety and feasibility of endoscopic cholecystolithotomy after endoscopic ultrasonography (EUS)-guided lumen-apposing metal stent (LAMS) implantation in animals.Methods:Six miniature pigs of 30-35 kg were selected to laparotomy under intravenous anesthesia. Two to four sterile human stones with diameter of 0.8-2.0 cm were implanted in their gallbladder. After successful modeling, LAMS was implanted between the stomach and gallbladder under the guidance of EUS. Ultrafine endoscope was used to search and remove stones after passing the gastric stent into the gallbladder. Endoscopic sphincterotomy (EST) and endoscopic retrograde biliary drainage (ERBD) was performed to prevent bile leakage. And then ordinary endoscope was used to remove LAMS and close the wound. The success rate, operation time, and incidence of complications were analyzed.Results:Five pigs were successfully implanted with LAMS, and the ultrafine endoscope entered the gallbladder smoothly. Small stones were removed from the stone basket, and large stones were completely removed after laser lithotripsy. The total operation time was 87-128 min. No postoperative complications such as bleeding, perforation, infection, or biliary fistula were observed. Failure in 1 pig was due to the first EST plus ERBD, resulting in rapid reduction of gallbladder volume and away from the gastric cavity leading to puncture difficulties.Conclusion:Endoscopic cholecystolithotomy after EUS-guided LAMS implantation is safe and feasible, and may provide animal experimental evidence for potential therapeutic approach for patients with difficulty in cholecystectomy.
ABSTRACT
Objective To compare coronary artery abnormality between patients with silent myocardial ischemia (SMI)and pa-tients with symptomatic myocardial ischemia using coronary artery CT angiography.Methods Forty-three patients with SMI and 45 patients with symptomatic myocardial ischemia were collected and underwent coronary CT angiography using 128-slices spiral CT scanner,respectively.Results Stenosis of coronary artery detected in 23 patients with SMI was (23/43,53.49%),and stenosis in 21 patients with symptomatic myocardial ischemia was (21/45,46.67%).The difference of incidence had no statistical significance, but the degree of stenosis and the number of stenosis vessel had statistical significance(P <0.05).The number of atherosclerotic plaque of coronary artery detected in patients with symptomatic myocardial ischemia was significantly more than that in patients with SMI(P <0.05).Conclusion There are no significant difference in the incidence of coronary stenosis between the patients with SMI and patients with symptomatic myocardial ischemia.However,the degree of stenosis and incidence of atherosclerotic plaque are sig-nificant different.