Published online Jul 7, 2020. doi: 10.3748/wjg.v26.i25.3603
Peer-review started: March 3, 2020
First decision: March 24, 2020
Revised: April 30, 2020
Accepted: May 27, 2020
Article in press: May 27, 2020
Published online: July 7, 2020
Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is an alternative method for the surgical treatment of gastric outlet obstruction (GOO), but it is regarded as a challenging technique for endoscopists as the bowel is highly mobile and can tent away. Thus, the technique requires superb skill. In order to improve EUS-GE, we have developed a retrievable puncture anchor traction (RPAT) device for EUS-GE to address the issue of bowel tenting.
One source of difficulty in EUS-GE is the high mobility of the intestine, which can tent away during puncture with a needle or electrocautery-enhanced delivery of lumen-apposing metal stents. In order to improve EUS-GE, we developed a RPAT method for EUS-GE. We evaluated the feasibility of the RPAT method using a pig model.
The present study aimed to use an animal model to evaluate the feasibility of RPAT-assisted EUS-GE.
Six Bama mini pigs each weighing between 15 and 20 kg underwent the RPAT-assisted EUS-GE procedure. Care was taken to ensure that the animals experienced minimal pain and discomfort. Two days prior to the procedure the animals were limited to a liquid diet. No oral intake was allowed on the day before the procedure. A fully covered metal stent was placed between the stomach and the intestine using the RPAT-assisted EUS-GE method. Infection in the animals was determined. Four weeks after the procedure, a standard gastroscope was inserted into the pig’s intestine through a previously created fistula in order to check the status of the stents under anesthesia. The pigs were euthanized after examination.
The RPAT-assisted EUS-GE method allowed placement of the stents with no complications in all six animals. All the pigs tolerated a regular diet within hours of the procedure. The animals were monitored for four weeks after the RPAT-assisted EUS-GE, during which time all of the animals exhibited normal eating behavior and no signs of infection were observed. Endoscopic imaging performed four weeks after RPAT-assisted EUS-GE showed that the stents remained patent and stable in all the animals. No tissue overgrowth or ingrowth was observed. Each animal had a mature fistula, and the stents were removed without significant bleeding. Autopsies of all six pigs revealed complete adhesion between the intestine and the stomach wall.
The RPAT method helps reduce mobility of the bowel. Therefore, the RPAT-assisted EUS-GE method is a minimally invasive treatment modality.
We proved the technical success of the RPAT method used with EUS-GE in a pig model. The RPAT method for EUS-GE is promising as a minimally invasive treatment. Clinical prospective trials are warranted to verify the efficacy of this treatment method. We are convinced that this treatment method can be widely used in EUS-GE in the future.