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. 2022 Jan 7;12(1):21.
doi: 10.1038/s41598-021-02921-9.

First fully endoscopic metabolic procedure with NOTES gastrojejunostomy, controlled bypass length and duodenal exclusion: a 9-month porcine study

Jean-Michel Gonzalez  1 , Sohaib Ouazzani  2 , Laurent Monino  2 , Laura Beyer-Berjot  3   4 , Stephane Berdah  3   4 , Nicolas Cauche  5 , Cecilia Delattre  5 , Joyce A Peetermans  6 , Peter Dayton  6 , Ornela Gjata  6 , Darren Curran  6 , Marc Barthet  2
Affiliations

First fully endoscopic metabolic procedure with NOTES gastrojejunostomy, controlled bypass length and duodenal exclusion: a 9-month porcine study

Jean-Michel Gonzalez et al. Sci Rep. .

Abstract

We conducted a pilot study of a potential endoscopic alternative to bariatric surgery. We developed a Natural Orifice Transluminal Endoscopic Surgery (NOTES) gastric bypass with controlled bypass limb length using four new devices including a dedicated lumen-apposing metal stent (GJ-LAMS) and pyloric duodenal exclusion device (DED). We evaluated procedural technical success, weight change from baseline, and adverse events in growing Landrace/Large-White pigs through 38 weeks after GJ-LAMS placement. Six pigs (age 2.5 months, mean baseline weight 26.1 ± 2.7 kg) had initial GJ-LAMS placement with controlled bypass limb length, followed by DED placement at 2 weeks. Technical success was 100%. GJ-LAMS migrated in 3 of 6, and DED migrated in 3 of 5 surviving pigs after mucosal abrasion. One pig died by Day 94. At 38 weeks, necropsy showed 100-240 cm limb length except for one at 760 cm. Weight gain was significantly lower in the pigs that underwent endoscopic bypass procedures compared to expected weight for age. This first survival study of a fully endoscopic controlled bypass length gastrojejunostomy with duodenal exclusion in a growing porcine model showed high technical success but significant adverse events. Future studies will include procedural and device optimizations and comparison to a control group.

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Conflict of interest statement

These authors disclose the following: Professor Barthet and Dr Gonzalez report Boston Scientific funding for research. Dr. Cauche and Dr. Delattre are full-time employees of Brussels Medical Device Center, which received a cooperative engineering grant from Boston Scientific Corporation. Dr. Peetermans, Mr. Dayton, Ms. Gjata and Mr. Curran are full-time employees of Boston Scientific Corporation. Dr. Ouazanni, Dr. Monino, Dr. Beyer-Berjot and Professor Berdah declare no competing interests.

Figures

Figure 1
Figure 1
Final devices used in the fully endoscopic jejunal bypass with duodenal exclusion procedure. (A) Enteral Beacon. (B) Atraumatic Grasper. (C) GJ-LAMS. (D) DED (final size: 34 mm long with 34-mm diameter flange).
Figure 2
Figure 2
Planned GJ-LAMS and DED placement and removal. GJ-LAMS gastrojejunal lumen-apposing metal stent, NOTES natural orifice transluminal endoscopic surgery, DED duodenal exclusion device.
Figure 3
Figure 3
Steps in the fully endoscopic jejunal bypass with duodenal exclusion procedure. (A) View of jejunal wall though the recently deployed GJ-LAMS. (B) Atraumatic removal of GJ-LAMS with grasper after 14 weeks of GJ-LAMS indwell. (C) View of jejunal wall through mature GJA after removal of the GJ-LAMS at the end of 13 weeks of indwell. (D) Mucosal abrasion before DED placement at Week 11. (E) DED immediately after deployment in the pylorus at Week 1. (F) DED shortly before atraumatic removal after 22 weeks of indwell. Tissue ingrowth is evident.
Figure 4
Figure 4
Placement, removal and migration of GJ-LAMS and DED in domestic pigs.
Figure 5
Figure 5
Pylorus, GJA and jejunal limb explanted upon necropsy at 38 weeks.
Figure 6
Figure 6
Domestic pig growth curves (A) for study animals and (B) compared to normal references,.
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References

    1. Younossi ZM, et al. Epidemiology of chronic liver diseases in the USA in the past three decades. Gut. 2019 doi: 10.1136/gutjnl-2019-318813. - DOI - PubMed
    1. Li J, Lai D, Wu D. Laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy to treat morbid obesity-related comorbidities: A systematic review and meta-analysis. Obes. Surg. 2016;26:429–442. doi: 10.1007/s11695-015-1996-9. - DOI - PubMed
    1. Courcoulas AP, et al. Long-term outcomes of bariatric surgery: A National Institutes of Health symposium. JAMA Surg. 2014;149:1323–1329. doi: 10.1001/jamasurg.2014.2440. - DOI - PMC - PubMed
    1. Caiazzo R, et al. Roux-en-Y gastric bypass versus adjustable gastric banding to reduce nonalcoholic fatty liver disease: A 5-year controlled longitudinal study. Ann. Surg. 2014;260:893–898. doi: 10.1097/SLA.0000000000000945. - DOI - PubMed
    1. Obeid NR, et al. Long-term outcomes after Roux-en-Y gastric bypass: 10- to 13-year data. Surg. Obes. Relat. Dis. 2016;12:11–20. doi: 10.1016/j.soard.2015.04.011. - DOI - PubMed

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