Brief Article
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World J Gastroenterol. Jun 14, 2013; 19(22): 3447-3452
Published online Jun 14, 2013. doi: 10.3748/wjg.v19.i22.3447
Endoscopic gastrojejunostomy with a natural orifice transluminal endoscopic surgery technique
Tae Jun Song, Dong Wan Seo, Su Hui Kim, Do Hyun Park, Sang Soo Lee, Sung Koo Lee, Myung-Hwan Kim
Tae Jun Song, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Koyang 411-706, South Korea
Dong Wan Seo, Do Hyun Park, Sang Soo Lee, Sung Koo Lee, Myung-Hwan Kim, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul 138-736, South Korea
Su Hui Kim, Asan Institute for Life Science, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, South Korea
Author contributions: Song TJ, Seo DW were responsible for the study concept and design, endoscopic procedures; Song TJ drafted the manuscript; Seo DW, Park DH, Lee SS, Lee SK and Kim MH critically revised the manuscript; Kim SH contributed to the material support and data acquisition.
Supported by A grant from the Asan Institute for Life Sciences, Seoul, South Korea, No. 2013-201
Correspondence to: Dong Wan Seo, MD, PhD, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap-2dong, Songpa-gu, Seoul 138-736, South Korea. dwseoamc@amc.seoul.kr
Telephone: +82-2-30103190 Fax: +82-2-4760824
Received: October 30, 2012
Revised: April 2, 2013
Accepted: April 18, 2013
Published online: June 14, 2013
Abstract

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.

Keywords: Natural orifice transluminal endoscopic surgery, Endoscopy, Pigs, Aanastomosis

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.