Gastrojejunostomy by pure natural orifice transluminal endoscopic surgery using a newly designed anastomosing metal stent in a porcine model

• Published in: Surgical endoscopy Vol. 28; no. 5; pp. 1439 - 1446
• Main Authors: Yi, Seung Woo, Chung, Moon Jae, Jo, Jung Hyun, Lee, Kyong Joo, Park, Jeong Youp, Bang, Seungmin, Park, Seung Woo, Song, Si Young
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01.05.2014; Springer Nature B.V
• Subjects: Abdominal Surgery; Animals; Disease Models, Animal; Endoscopy; Female; Gastric Bypass - methods; Gastric Outlet Obstruction - surgery; Gastroenterology; Gynecology; Hepatology; Laboratory animals; Medical research; Medicine; Medicine & Public Health; Natural Orifice Endoscopic Surgery - methods; Palliative Care - methods; Proctology; Prosthesis Design; Small intestine; Stents; Stomach; Surgery; Sutures; Swine; Ventilators; Self-expandable metal stents; Compression anastomosis; Natural orifice endoscopic surgery; Gastrojejunostomy
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-013-3371-z

Background The accepted palliative treatment for malignant gastric outlet obstruction (GOO) is surgical bypass or placement of self-expandable metal stents. We developed a safe and simple natural orifice transluminal endoscopic surgery (NOTES) technique for gastrojejunostomy using a fully covered, anastomosing metal stent in a porcine model. Methods Under general anesthesia, 11 pigs underwent gastrojejunostomy with a 4 cm length anastomosing metal stent. After gastrotomy formation using a needle knife, the jejunum was drawn into the stomach with alligator forceps. A jejunotomy was then performed in the gastric cavity, which was followed by deployment of an anastomosing metal stent under fluoroscopic guidance. Next, the first portion of the duodenum was resected by an endoscopic linear stapler via laparoscopy, thereby creating the model of GOO. Oral feeding was resumed 24 h after the procedure, and animals were euthanized at 1, 2, and 4 weeks after the operation. Results Side-to-side gastrojejunostomy was successfully completed through NOTES in 10/11 animals. Ten pigs stayed healthy until the planned sacrifice. The mean gastrojejunostomy procedure time was 41 min (range 15–94 min). By postmortem examination, anastomoses were still intact without intraperitoneal necrosis or adhesion. Histological examination revealed adequate submucosal apposition in all ten experimental pigs undergoing successful endoscopic gastrojejunostomy. Conclusion Creating a gastrojejunostomy by NOTES using an anastomosing metal stent seems to be a safe, feasible, durable, and reproducible method for GOO.