New methodExperimental endoscopyNovel EUS-guided gastrojejunostomy technique using a new double-balloon enteric tube and lumen-apposing metal stent (with videos)
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.
References (10)
- et al.
Palliative surgery for unresectable pancreatic and periampullary cancer: a reappraisal
J Gastrointest Surg
(2006) - et al.
A through-the-scope device for suturing and tissue approximation under EUS control
Gastrointest Endosc
(2002) - et al.
Transluminal endosurgery: single lumen access anastomotic device for flexible endoscopy
Gastrointest Endosc
(2003) - et al.
Clinical evaluation of a novel lumen-apposing metal stent for endosonography-guided pancreatic pseudocyst and gallbladder drainage (with video)
Gastrointest Endosc
(2012) - et al.
Endoscopic magnetic gastroenteric anastomosis for palliation of malignant gastric outlet obstruction: a prospective multicenter study
Gastrointest Endosc
(2010)
Cited by (94)
Endoscopic Treatment of Gastric Outlet Obstruction
2024, Gastrointestinal Endoscopy Clinics of North AmericaEndoscopic gastrointestinal anastomosis: a review of established techniques
2021, Gastrointestinal EndoscopyGastrointestinal stents: Thinking outside the box
2020, Techniques and Innovations in Gastrointestinal Endoscopy
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].