Basic Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 7, 2019; 25(21): 2623-2635
Published online Jun 7, 2019. doi: 10.3748/wjg.v25.i21.2623
Endoscopic resection of the pancreatic tail and subsequent wound healing mechanisms in a porcine model
Sheng Wang, Kai Zhang, Jin-Long Hu, Wei-Chao Wu, Xiang Liu, Nan Ge, Jin-Tao Guo, Guo-Xin Wang, Si-Yu Sun
Sheng Wang, Kai Zhang, Jin-Long Hu, Wei-Chao Wu, Xiang Liu, Nan Ge, Jin-Tao Guo, Guo-Xin Wang, Si-Yu Sun, Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
Author contributions: Wang S designed the research; Wang S, Zhang K, and Wu WC performed the research; Liu X, Ge N, Guo JT, and Wang GX analyzed the data; Wang S and Hu JL wrote the manuscript; Sun SY approved the final manuscript.
Institutional animal care and use committee statement: This study was reviewed and approved by the Ethics Committee of the Shengjing Hospital of China Medical University.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: No additional data are available.
ARRIVE guidelines statement: The manuscript was prepared according to the ARRIVE Guidelines.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Si-Yu Sun, MD, PhD, Chief Doctor, Professor, Endoscopy Center, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Shenyang 110001, Liaoning Province, China. sunsy@sj-hospital.org
Telephone: +86-18940251329 Fax: +86-24-9661526111
Received: March 7, 2019
Peer-review started: March 7, 2019
First decision: March 27, 2019
Revised: May 6, 2019
Accepted: May 8, 2019
Article in press: May 8, 2019
Published online: June 7, 2019
Abstract
BACKGROUND

Laparoscopic resection of the pancreatic body and tail is the predominant methodology to remove lesions in these locations; its safety and surgical planning are relatively mature, but it remains a complex and high-precision surgical operation, requiring abundant experience and skills in laparoscopic surgery, with a 10% rate of complications.

AIM

To verify the feasibility and safety, as well as to examine the complications of endoscopic pancreatectomy and healing mechanisms of pancreatic wounds after endoscopic resection.

METHODS

Transgastric endoscopic resections of varying sizes of pancreases were performed in 15 healthy Bama miniature pigs. The technical success rate, the incidence of serious complications, and the survival of the animals were studied. The healing of the wounds was evaluated by sacrificing the animals at various time points. Finally, the expression of transforming growth factor-β1 and Smad3/Smad7 in the surgical site was examined by immunohistochemistry to explore the role of these factors in wound healing of the pancreas.

RESULTS

Partial and total resections were successfully performed in two groups of animals, respectively. The technical success rate and the survival rate of the pigs were both 100%. We obtained 12 pancreatic tissue samples by endoscopic resection. The pancreatic wounds were closed with metal clips in one group and the wounds healed well by forming scars. There was a small amount of pancreatic leakage in the other group, but it can be fully encapsulated. The level of transforming growth factor-β1 (TGF-β1) in the wounds increased during the inflammatory and fibrous hyperplasia phases, and decreased in the scar phase. The expression of Smad3 paralleled that of TGF-β1, while the expression of Smad7 had an inverse relationship with the expression of TGF-β1.

CONCLUSION

Purely transgastric endoscopic resection of the pancreas is a safe, effective, and feasible procedure, but the incidence of pancreatic leakage in total pancreatic tail resection is high. The expression of TGF-β1 and Smad3/Samd7 is related to the progression of pancreatic wound healing.

Keywords: Pancreatic resection, Endoscopy, Wound healing, Transforming growth factor-β1, Smad

Core tip: Purely transgastric endoscopic resection of the pancreas is a safe, effective, and feasible procedure. Endoscopic partial resection of the pancreatic tail is safe, but the incidence of pancreatic leakage in total pancreatic tail resection is high. Wound closure with metal clips is effective in reducing pancreatic leakage and in helping to form scar tissue at the wound site. The expression of transforming growth factor-β1 and Smad3/Samd7 varies in different phases of pancreatic wound healing, illustrating the relation of these factors to the progression of wound healing.