Transgastric anastomosis using flexible endoscopy in a porcine model (video)

Background Transgastric flexible endoscopic anastomosis might offer advantages over open and laparoscopic surgery especially for bariatrics or patients with obstructive malignancy. Objective Develop methods for performing transgastric anastomosis. Design/results Twelve gastrojejunal anastomoses were...

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Bibliographic Details
Published in:Gastrointestinal endoscopy 2006-02, Vol.63 (2), p.307-312
Main Authors: Bergström, Maria, MD, Ikeda, Keiichi, MD, Swain, Paul, MD, Park, Per-Ola, MD
Format: Article
Language:English
Subjects:
Animals
Biological and medical sciences
Disease Models, Animal
Endoscopes, Gastrointestinal
Endoscopy, Gastrointestinal - methods
Equipment Design
Follow-Up Studies
Gastroenterology and Hepatology
Gastroenterology. Liver. Pancreas. Abdomen
Gastroenterostomy - methods
Jejunum - surgery
Medical sciences
Stomach - surgery
Swine
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Summary:Background Transgastric flexible endoscopic anastomosis might offer advantages over open and laparoscopic surgery especially for bariatrics or patients with obstructive malignancy. Objective Develop methods for performing transgastric anastomosis. Design/results Twelve gastrojejunal anastomoses were formed in pigs weighing 27 kg to 38 kg (six each in survival and nonsurvival groups) using a per-oral double-channel gastroscope. The stomach was penetrated using a needle-knife guidewire combination and bow-sphincterotome incision. The small intestine (SI) was grasped with a snare-over-forceps method and pulled into the stomach for suturing. Sutures were placed in pairs through the deep muscle of the stomach and small intestine to join the tissues securely. The SI was incised with a needle-knife to open the anastomosis. Anastomoses were placed close to the cardioesophageal junction for bariatric purposes or in the antrum for pancreatic bypass. Survival studies in six pigs showed anastomosis patency at 7 to 10 days. Conclusion Gastrojejunal anastomosis was accomplished via the transgastric route using a new double-channel endoscopic method.
ISSN:0016-5107
1097-6779
DOI:10.1016/j.gie.2005.09.035