Published online Jun 14, 2013. doi: 10.3748/wjg.v19.i22.3447
Revised: April 2, 2013
Accepted: April 18, 2013
Published online: June 14, 2013
AIM: To determine the technical feasibility and safety of an endoscopic gastrojejunostomy with a pure natural orifice transluminal endoscopic surgery (NOTES) technique using a T-anchoring device in a porcine survival model.
METHODS: An endoscopic gastrojejunostomy with a pure NOTES technique using a T-anchoring device was performed on 10 healthy female minipigs weighing approximately 40 kg each under general anesthesia. All procedures were performed with a transgastric approach using a 2-channel therapeutic endoscope.
RESULTS: The transgastric gastrojejunostomy was technically successful in all cases. A total of four to six stitched pairs of a T-anchoring device were used to secure the anastomosis. The median time required to enter the peritoneal cavity and pull the small bowel into the stomach was 34 min (range: 19-41 min); the median time required to suture the anastomosis was 67 min (range: 44-78 min). An obstruction of the efferent limb occurred in one case, and a rupture of the anastomosis site occurred in another case. As a result, the functional success rate was 80% (8/10). Small bowel adhesion to the stomach and liver occurred in one case, but the anastomosis was intact without leakage or obstruction.
CONCLUSION: A transgastric gastrojejunostomy with a T-anchoring device may be safe and technically feasible. A T-anchoring device may provide a simple and effective endoscopic suturing method.
Core tip: Natural orifice transluminal endoscopic surgery (NOTES) have become part of the growing trend of minimally invasive surgery and have been gradually used in more diverse areas. An endoscopic gastrojejunostomy using a pure NOTES technique may be attractive because it can be a simple and less invasive method for bypassing a gastric outlet or duodenal obstruction. An endoscopic transgastric gastrojejunostomy with T-anchoring devices may be a technically feasible, useful alternative to invasive surgery. However, a great deal of care and further improvement is needed because of the risk of procedure-related complications.