Elsevier

Gastrointestinal Endoscopy

Volume 78, Issue 6, December 2013, Pages 934-939
Gastrointestinal Endoscopy

New method
Experimental endoscopy
Novel EUS-guided gastrojejunostomy technique using a new double-balloon enteric tube and lumen-apposing metal stent (with videos)

https://doi.org/10.1016/j.gie.2013.09.025Get rights and content

Background

Surgical gastrojejunostomy is associated with relatively high morbidity and mortality rates. However, current experimental EUS-guided gastrojejunostomy information is limited.

Objective

To evaluate a novel EUS-guided gastrojejunostomy technique using a new enteric balloon and lumen-apposing metal stent.

Design

Animal experiment.

Setting

Animal laboratory at a referral center.

Subjects and Interventions

In 5 pigs, gastrojejunostomies were created under EUS guidance. Fully covered lumen-apposing stents were placed between the stomach and the jejunum.

Main Outcome Measurements

Technical success and adverse events of EUS-guided gastrojejunostomy.

Results

All stents, with 1 exception, were successfully deployed without any adverse events. The mean time to stent placement was 44.2 minutes (range 28-64 minutes). All animals showed normal eating behavior without signs of infection for 1 month after the procedure. Endoscopic imaging of the stomach site showed the stent to be patent and stable, without dislodgment, in all of the pigs. Necropsy showed complete adhesion between the stomach and the jejunum wall.

Limitations

Pilot study.

Conclusions

Creation of an EUS-guided gastrojejunostomy by using a novel enteric balloon and metal stent appears to be promising as a minimally invasive treatment.

Section snippets

Animal model

Survival experiments were performed on 5 female pigs with a bodyweight of 25 to 30 kg. Institutional review board approval was obtained from the local animal ethics committee (IRB no. 12085-0), and animals were housed at an animal research facility (Minimally Invasive Treatment Animal Laboratory Center, Keio University, Tokyo, Japan). Intramuscular midazolam (0.2 mg/kg), medetomidine (0.1 mg/kg), and atropine sulfate (0.02 mg/kg) were used to induce general anesthesia, which was maintained by

Results

Placement of the enteric tube was successful in all cases (Video 1, available online at www.giejournal.org). The mean procedure time of tube placement was 19.2 minutes (range 12-35 minutes) (Table 1). EUS could depict the distended jejunum between the 2 balloons (Fig. 4) in all cases. Placement of the metal stent was also successful in all cases (Video 2, available online at www.giejournal.org). In 1 case (case 3), the distal flange was misdeployed in the stomach. Eventually, successful

Discussion

We developed a new enteric tube that can trap the fluid between the double balloons. It maintains the distention of the small bowel between the double balloons at the initial FNA needle puncture without the need to use tissue-opposing devices such as tilt tags.5, 6, 7 In addition, this system is very efficient because additional fluid can be easily injected to distend the small bowel when it collapses after a needle puncture or bougie use. In this study, all procedures were performed smoothly.

Acknowledgments

We are grateful to Clifford A. Kolba, EdD, DO, MPH, and Edward F. Barroga, DVM, PhD, of the Department of International Medical Communications of Tokyo Medical University for their editorial review of the manuscript. We are also grateful to Motoki Sasaki, an endoscopic technician at the Division of Research and Development for Minimally Invasive Treatment, Keio University, School of Medicine for his support in this experimental study.

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DISCLOSURE: The following author disclosed financial relationships relevant to this publication: Dr Itoi is a speaker for Olympus and a consultant to Xlunema. The other authors disclosed no financial relationships relevant to this publication. The novel reflected metal stents were provided free of charge by Taewoong-Medical Co Ltd (Seoul, Korea). This study was funded in part by Taewoong-Medical.

If you would like to chat with an author of this article, you may contact Dr Itoi at [email protected].

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