Comparative Study of NOTES Versus Endoscopic Ultrasound Gastrojejunostomy in Pigs: A Prospective Study. (February 2018)

• Record Type: Journal Article
• Authors: Ungureanu, Bogdan Silviu; Pătrașcu, Ștefan; Drăgoescu, Alice; Nicolau, Carmen; Copăescu, Cătălin; Șurlin, Valeriu; Săftoiu, Adrian
• Is Part Of: Surgical innovation. Volume 25:Number 1(2018)
• Page Start: 16
• Page End: 21
• Publication Date: 2018-02
• Subjects: NOTES -- flexible endoscopy -- interventional endoscopy; Surgery, Operative -- Periodicals; Endoscopic surgery -- Periodicals; Laparoscopic surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgical Procedures, Minimally Invasive -- Periodicals; Diffusion of Innovation -- Periodicals; Chirurgie opératoire -- Périodiques; Chirurgie endoscopique -- Périodiques; Chirurgie laparoscopique -- Périodiques; 617.91
• DOI: 10.1177/1553350617748278
• Languages: English
• ISSNs: 1553-3506

Abstract

Background. Surgical gastrojejunal anastomosis (GJJ) is considered the standard palliative option for gastric outlet obstruction. The use of endoscopic GJJ has generated a lot of attention and has enlarged the horizon for patients with open surgery contraindications. Our study aimed to assess and compare 2 purely endoscopic GJJ approaches using a lumen-apposing hot tip double-flanged metal stent, with focus on technical and clinical success rates on experimental animals. Methods. Two endoscopic GJJ techniques using a double-flanged self-expandable metal stent were compared on 8 pigs. Natural orifice transluminal endoscopic surgery (NOTES) was used on 4 pigs, while the other group was subjected to an endoscopic ultrasound (EUS) balloon-guided approach. Results. On a 21-day follow-up, both EUS and NOTES-GJJ were technically successful in all experimental animals, and necropsy confirmed full integrity of the anastomosis. Adhesions were confirmed only on 2 pigs after NOTES procedure. The mean time for GJJ-NOTES completion was 31.375 ± 2.03, whereas EUS-GJJ was completed with a median time of 20.275 ± 0.65. The stent distance from the stomach varied; in NOTES-GJJ it was 47.8 ± 11.13 cm away from the pylorus, whereas in EUS-GJJ was at 37 ± 1.85 cm. Conclusion. No major complications were encountered during both procedures. EUS-GJJ balloon-guided approach might be a more attractive technique by using sonographic guidance, because of less endoscopic instrument changing as well as in achieving the desired anastomotic distance.