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. 2015 Oct 25;7(15):1186-90.
doi: 10.4253/wjge.v7.i15.1186.

Transgastric endoscopic gastrojejunostomy using holing followed by interrupted suture technique in a porcine model

Su-Yu Chen  1 , Hong Shi  1 , Sheng-Jun Jiang  1 , Yong-Guang Wang  1 , Kai Lin  1 , Zhao-Fei Xie  1 , Xiao-Jing Liu  1
Affiliations

Transgastric endoscopic gastrojejunostomy using holing followed by interrupted suture technique in a porcine model

Su-Yu Chen et al. World J Gastrointest Endosc. .

Abstract

Aim: To demonstrate the feasibility and reproducibility of a pure natural orifice transluminal endoscopic surgery (NOTES) gastrojejunostomy using holing followed by interrupted suture technique using a single endoloop matched with a pair of clips in a non-survival porcine model.

Methods: NOTES gastrojejunostomy was performed on three female domestic pigs as follows: Gastrostomy, selection and retrieval of a free-floating loop of the small bowel into the stomach pouch, hold and exposure of the loop in the gastric cavity using a submucosal inflation technique, execution of a gastro-jejunal mucosal-seromuscular layer approximation using holing followed by interrupted suture technique with endoloop/clips, and full-thickness incision of the loop with a Dual knife.

Results: Pure NOTES side-to-side gastrojejunostomy was successfully performed in all three animals. No leakage was identified via methylene blue evaluation following surgery.

Conclusion: This novel technique for preforming a gastrointestinal anastomosis exclusively by NOTES is technically feasible and reproducible in an animal model but warrants further improvement.

Keywords: Endoloop; Endoscopic clips; Endoscopic gastrojejunostomy; Natural orifice transluminal endoscopic surgery; Pigs.

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Figures

Figure 1
Figure 1
Step-by-step procedure of pure natural orifice transluminal endoscopic surgery side-to-side gastrojejunostomy. A: Endoscopic view of a loop of the small bowel in the stomach grasped by an endoscopic alligator forceps on its anti-mesenteric side; B: Image taken during submucosal injection around the loop; C: Endoscopic view of one hole made on gastric mucosal surface; D: Endoscopic view of an endoloop placed around the hole; E: Endoscopic view of one clip clipped to anchor the endoloop on the side of the stomach after the prong of the clip was inserted in the hole of the stomach wall; F: Endoscopic view of the second clip clipped to anchor the endoloop on the side of the small intestine; G: Endoscopic view of the endoloop tightened to approximate the gastric mucosal layer and the intestinal serosal layer; H: Endoscopic view of gasto-jejunal mucosal-seromuscular layer anastomosis followed by the loop full-thickness incision.
Figure 2
Figure 2
Postmortem appearances of anastomosis. A: Macroscopic appearance showing that the intestinal wall had been joined to the stomach wall; B: Macroscopic appearance of gastrointestinal side-to-side anastomosis; C: Methylene blue instilled into the anastomotic lumen; D: No methylene blue observed on the surface of gastric serosa around the anastomosis.
See this image and copyright information in PMC

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