Korean J Radiol.  2004 Jun;5(2):114-120. 10.3348/kjr.2004.5.2.114.

Newly Designed Sheaths for Gastroduodenal Intervention: An Experimental Study in a Phantom and Dogs

• Seo TS
• Song HY
• Lee JH
• Ko GY
• Sung KB
• Lim JO
• Ko YH

• KMID: 753991
• DOI: http://doi.org/10.3348/kjr.2004.5.2.114

Abstract

OBJECTIVE
To evaluate the usefulness of newly designed sheaths for gastroduodenal intervention in a gastric phantom and dogs. MATERIALS AND METHODS: A regular sheath was made using a polytetrafluoroethylene tube (4 mm in diameter, 90 cm long) with a bent tip (4 cm long, 100 degree angle). For the supported type of sheath, a 5 Fr catheter was attached to a regular sheath to act as a side lumen. To evaluate their supportability, we measured the distance of movement of the sheath's tip within a silicone gastric phantom for three types of sheath, the regular type, supported type, and supported type with a supporting guide wire. The experiments were repeated 30 times, and the results were analyzed using ANOVA with the postHoc test. In addition, an animal experiment was performed in six mongrel dogs (total: 12 sessions) to evaluate the torque and supportability of the sheaths in the stomach, while pushing a guide wire or coil catheter under fluoroscopic guidance. RESULTS: In the guide wire application, the distances of movement of the sheath tip in the three types of sheath, the regular type, supported type, and supported type with supporting guide wire, were 8.40+/-0.51 cm, 6.23+/-0.41 cm, and 4.47+/-0.32 cm, respectively (p < 0.001). In the coil catheter application, the corresponding values were 7.22+/-0.70 cm, 5.61+/-0.31 cm and 3.91+/-0.59 cm, respectively (p < 0.001). All three types of sheath rotated smoothly and enabled both the wires and catheters to be guided toward the pylorus of the dog in all cases. CONCLUSION: The newly designed sheaths can be useful for gastroduodenal intervention.

Keyword

Gastrointestinal tract; Interventional procedures; Stents and Prostheses

MeSH Terms

Animals
Dogs
*Duodenum
Equipment Design
Intubation/*instrumentation
Phantoms, Imaging
*Radiography, Interventional
Stents
*Stomach
Support, Non-U.S. Gov't

Figure

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  Fig. 1 A regular sheath (left) and supported sheath with a supporting wire in the side lumen (right).

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  Fig. 2 A. An outline of the stomach was drawn, in order to make the gastric phantom, as follows. The distances from the greater to lesser curvature were measured in each section on the abdominal CT scan. The locations of the greater curvature on one section relative to that on the next section on the abdominal CT scan were also evaluated. Both the distances and relative locations were plotted on a 2-dimensional plane; subsequently, the contour of the greater and lesser curvature of the stomach was drawn by connecting these points on a 2-dimensional plane. The esophageal outline was drawn from the esophagus to the cardia, with a diameter of 2 cm and a length of 5 cm. B. Clay was shaped, so as to be 2 cm in height, and to follow the gastric contour with a tubular shape at the esophageal portion.

• 

  Fig. 3 A. A guide wire is inserted in a supported sheath, and a supporting wire is inserted into the gastric portion through the side lumen. When the supporting wire is pushed, the tip of the wire is pressed against the greater curvature side of the gastric phantom. B. The distance of movement of the tip of the supported sheath from the central point was measured while pushing the guide and supporting wire, and was found to be approximately 4 cm.

• 

  Fig. 4 A. A regular sheath is inserted into the gastric portion via the esophageal portion, and a coil catheter is advanced beyond the pyloric portion. B. The distance between the central point and point of the tip of the sheath is approximately 6 cm.

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  Fig. 5 Experimental study in dogs. While pushing a coil catheter through the sheath, the direction is changed from the long axis of the esophagus to the transverse axis oriented toward the pylorus in the stomach. The coil catheter is then advanced to the pylorus with support from the sheath, without any kinking occurring in the stomach.

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