| BackgroundA natural disaster as a unique,indirect condition makes psychological stress and human peptic ulcer contact.When individuals suffer severe psychological stress,the body instinctively reacts aggressively on the function and structure,and the neural,humoral,inflammatory mediators and cytokines will be involved in these reacts,and mediate stomach and duodenum mucosal lesions,which was called stress-related mucosal disease(SRMD).For the disaster rescue of the diagnosis of digestive tract disease on site,Japan has put gastrointestinal endoscopy ambulance into use,however,the application results also need to be further confirmed.Considering the general conditions harsh of the affected areas,many victims and the time of onset of the population concentrated,and then endoscopic equipment having large volume,poor mobility and needing specialized disinfection equipment,traditional endoscopic screening of SRMD is clearly unrealistic.Digestive endoscopic physician lack on disaster rescue sit,moreover,water and electricity supply often obstacles.Especially in China,traditional gastrointestinaloscopy is currently not suitable for disease screening on disaster site.Even if it is possible to carry out traditional endoscopy for the disaster rescue,which is not the first site.Corresponding treatment measures and equipments for SRMD related to disaster have not been reported.Facing a series of problems prompted us to try to solve these problems and strive to innovate.Considering that the capsule endoscopy(CE)is lightweight,portable,easy to use,having been applied to the clinic maturely,and has the potential to remotely transmit the captured images.We carry out a preliminary study on the diagnosis of stress-induced mucosal injury for disaster rescue on site by using capsule endoscope.This study preliminarily want to establish a method for dogs’ s upper gastrointestinal examination by using an ordinary capsule endoscope and observe the effect of monitoring and diagnosing the animal model of stress-induced mucosal lesion in upper gastrointestinal tract,and then provide a new method and theoretical basis for safety and rapid endoscopic diagnosis of patients with stress-induced gastric mucosal lesions in harsh conditions such as disaster scene and battlefield.ObjectiveIn this study,we reformed the instructions of capsule endoscopy,and explore the method and feasibility of reformed capsule endoscopy in real-time examination for upper gastrointestinal mucosal disease at larger animals like beagles.Expect to provide a simple and continuous observation method for the apparent changes of the occurrence and development of acute lesion of digestive tract mucosa,and to provide a new method and theoretical foundations for the safe,real-time and rapid endoscopic diagnosis of acute lesion of digestive tract mucosa.Method1.Improve the conventional capsule endoscope The modified capsule endoscope system includes capsule endoscope,gastric tube,and traction line.The traction line was sutures-4(Or equal diameter white cotton thread),whose one end was tied to the capsule endoscope waist,and the other end was taken from the top of the gastric tube through the lumen and out of the tube from a side hole.Capsule endoscope could resist the top of gastric tube by stretching the line,then the operator could change the shooting position and angle of capsule endoscope.2.Put capsule endoscopy into Beagle’s stomach Mixing Zoletil50(2.5mg/kg)with Xylazine hydrochloride injection(0.025ml/kg),intramuscular.Maintain anesthesia medication accounted 1/3 for the initial dose,sub-head intravenous injection on-demand.When Beagle dogs were calmed and still have swallowing reflex,operator puted the reformed CE into the dog esophageal and stomach timely with the gastric tube assistance.3.Make animal model of acute gastric mucosal lesion and achieve real-timeobservation Under the prerequisites of reformed CE in the stomach,40% glacial acetic acid 40 ml gavage through the gastric tube to make acute gastric mucosal lesion animal model.The capsule endoscope captures the gastric mucosal images continuously at a rate of 5 frames per second.Results1.Reformed capsule endoscopes successfully be used in larger animals Simply modifiate PillCam SB2 CE,manufactured by Given Imaging,Israel.String capsule endoscopy with the assisitance of gastric tube stimulate the swallowing reflex in order to help the reformed CE to pass through the esophagus entrance.Operator could successfully put reformed CE into the anesthesia dogs’ s esophagus and stomach within the10.54±1.64 min.At the gastric cavity,by stretching the cotton thread could make capsule endoscope against the top of tube,and the presence of the guide wire lead the stomach tube having a certain stiffness.On this time through pulling cotton thread could change the front curvature and direction,then to change the shooting position and viewing angle of the CE,and at the end of observation pulling the CE out of stomach(there is no line breakage and capsule detachment).2.Acute gastric mucosal lesion animal model successfully be established 40%glacial acetic acid 40 ml gavage by the gastric tube,through the display observed that the gastric mucosa immediately change from the normal pink to pale gradually,and the other local visible flaky and hemorrhagic foci appeared.The lesion area continued to expand,and approximately wasting 9.89±0.15 min mucosa eventually appeared extensive erosion bleeding showing gray-brown with multiple bleeding area.Successfully established animal model of acute gastric mucosal lesion.3.Capsule endoscope realized real-time monitoring mucosal changes in gastrointestinal disease animal model Capsule endoscope realized real-time monitoring mucosal changes in gastrointestinal disease animal model.The initial display showed normal mucosa surface smooth,moist,orange,and tissue structure outline clear,when 40%glacial acetic acid 40 ml gavage through the gastric tube,immediately the mucosa colour changed from the red to slightly pale and rough.The degree of mucosa acute injury gradually increased with the time prolongation,and the process of injury was continuous and the screen showed continuous dynamic change.10 min after intragastric administration,the mucosa has been gray-brown with multiple flaky bleeding area,a large number of exudate surface and blurred tissue profile.The effect of flushing mucosal surface attachment was poor,and capsule endoscopic shooting field of view also be affected.Capsule endoscopy can clearly capture the gastric mucosa,and observe different apparent changes of gastric mucosa at different time,then finally achieved real-time monitoring the mucosal changes of digestive tract disease in animal model.ConciusionTo reforme Instructions of common capsule endoscopy,and successfully establish a method,whcih could realize that a common capsule endoscopy monitor the occurrence and development of acute digestive tract mucosal lesions in real time.It was feasible to observe apparent changes of gastric mucosal acute injury process of beagle dog or other larger animals at its initial application. |
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