Basic Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 7, 2016; 22(37): 8375-8381
Published online Oct 7, 2016. doi: 10.3748/wjg.v22.i37.8375
Percutaneous transgastric endoscopic tube ileostomy in a porcine survival model
Hong Shi, Su-Yu Chen, Yong-Guang Wang, Sheng-Jun Jiang, He-Li Cai, Kai Lin, Zhao-Fei Xie, Fen-Fang Dong
Hong Shi, Su-Yu Chen, Zhao-Fei Xie, Department of Gastrointestinal Endoscopy, Fujian Provincial Cancer Hospital, Affiliated Cancer Hospital of Fujian Medical University, Fuzhou 350014, Fujian Province, China
Yong-Guang Wang, Sheng-Jun Jiang, Department of Minimally Invasive Surgery, Beijing Chuiyangliu Hospital, Institute of Minimally Invasive Medicine of Tongji University, Beijing 100022, China
He-Li Cai, Department of Gastroenterology, Fuzhou Seventh Hospital, Fuzhou 350001, Fujian Province, China
Kai Lin, Department of General Surgery, Fuzhou Seventh Hospital, Fuzhou 350001, Fujian Province, China
Fen-Fang Dong, Faculty of Medical Technology and Engineering, Fujian Medical University, Fuzhou 350004, Fujian Province, China
Author contributions: Shi H and Chen SY contributed equally to this work; Shi H and Chen SY were responsible for the study concept and design, including endoscopic procedures; all authors conducted the endoscopic operations together; Chen SY drafted the manuscript; Shi H revised and finalized the manuscript.
Supported by the Natural Science Foundation Project of Fujian Provincial Department of Science and Technology, No. 2014J01407; the Fuzhou Technology Planning Project, No. 2013-S-129-2; and the College Students’ Innovation and Entrepreneurship Planning Project of Fujian Medical University, No. C1503.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Fujian Provincial Tumor Hospital, Teaching Hospital of Fujian Medical University (protocol number: 2014J01407, 2013-S-129-2, C1503).
Conflict-of-interest statement: To the best of our knowledge, no conflict of interest exists.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Hong Shi, MD, Department of Gastrointestinal Endoscopy, Fujian Provincial Cancer Hospital, Affiliated Cancer Hospital of Fujian Medical University, Fuzhou 350014, Fujian Province, China.
Telephone: +86-591-83660063 Fax: +86-591-83660063
Received: July 8, 2016
Peer-review started: July 12, 2016
First decision: August 8, 2016
Revised: August 18, 2016
Accepted: August 30, 2016
Article in press: August 30, 2016
Published online: October 7, 2016

To introduce natural orifice transgastric endoscopic surgery (NOTES) tube ileostomy using pelvis-directed submucosal tunneling endoscopic gastrostomy and endoscopic tube ileostomy.


Six live pigs (three each in the non-survival and survival groups) were used. A double-channeled therapeutic endoscope was introduced perorally into the stomach. A gastrostomy was made using a 2-cm transversal mucosal incision following the creation of a 5-cm longitudinal pelvis-directed submucosal tunnel. The pneumoperitoneum was established via the endoscope. In the initial three operations of the series, a laparoscope was transumbilically inserted for guiding the tunnel direction, intraperitoneal spatial orientation and distal ileum identification. Endoscopic tube ileostomy was conducted by adopting an introducer method and using a Percutaneous Endoscopic Gastrostomy Catheter Kit equipped with the Loop Fixture. The distal tip of the 15 Fr catheter was placed toward the proximal limb of the ileum to optimize intestinal content drainage. Finally, the tunnel entrance of the gastrostomy was closed using nylon endoloops with the aid of a twin grasper. The gross and histopathological integrity of gastrostomy closure and the abdominal wall-ileum stoma tract formation were assessed 1 wk after the operation.


Transgastric endoscopic tube ileostomy was successful in all six pigs, without major bleeding. The mean operating time was 71 min (range: 60-110 min). There were no intraoperative complications or hemodynamic instability. The post-mortem, which was conducted 1-wk postoperatively, showed complete healing of the gastrostomy and adequate stoma tract formation of ileostomy.


Transgastric endoscopic tube ileostomy is technically feasible and reproducible in an animal model, and this technique is worthy of further improvement.

Keywords: Natural orifice transluminal endoscopic surgery, Tube ileostomy, Endoloop, Pigs, Submucosal tunneling

Core tip: A novel technique, natural orifice transgastric endoscopic surgery tube ileostomy, may be successfully performed in a porcine survival model using pelvis-directed submucosal tunneling endoscopic gastrostomy, followed by endoscopic tube ileostomy using an Introducer Kit containing a loop fixture.