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Endosc Int Open 2013; 1(01): 31-38
DOI: 10.1055/s-0033-1353686
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Evaluation of feasibility, efficiency and safety of a pure NOTES gastrojejunal bypass with gastric outlet obstruction, in an in vivo porcine model

J.-M. Gonzalez
1   Department of Gastroenterology, Public Assistance Hospitals of Marseille, North Hospital, Marseille, France
2   Department of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
,
E. A. Bonin
1   Department of Gastroenterology, Public Assistance Hospitals of Marseille, North Hospital, Marseille, France
,
G. Vanbiervliet
3   Department of Endoscopy, University Hospital of Nice, Nice, France
,
E. Garnier
4   Aix-Marseille University, CERC, Faculty of Medicine, Marseille, France
,
S. Berdah
5   Department of Digestive Surgery, Public Assistance Hospitals of Marseille, Marseille, France
,
K. Matthes
2   Department of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
,
M. Barthet
1   Department of Gastroenterology, Public Assistance Hospitals of Marseille, North Hospital, Marseille, France
› Author Affiliations
Further Information

Publication History

received 23 May 2013

accepted after revision 05 December 2013

Publication Date:
19 December 2013 (online)

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Introduction: Natural orifice transluminal endoscopic surgery (NOTES) gastrojejunal anastomosis (GJA) is a less invasive surgery for bariatric procedures and gastric outlet obstruction. The aim of this study was to evaluate the feasibility, efficacy, and safety of a pure NOTES gastrojejunal bypass using an in vivo porcine model.

Material and methods: A prospective study was performed on nine swine. A double-channel scope was used. The intervention steps were: (i) gastric incision; (ii) peritoneal access; (iii) jejunal loop selection and mobilization into the stomach; (iv) stoma creation within the gastric wall and incision; (v) anastomosis suture and pylorus closure using a T-tag prototype. The animals were assessed clinically for 3 weeks including the weight gain. The patency of the GJA was assessed at necropsy and a histological analysis was performed.

Results: We successfully performed all the procedures with a mean (standard deviation [SD]) operative time of 108 (26) minutes. We used a mean of 5.55 (1.30) stitches. There were no intraprocedural adverse events. Five animals survived up till euthanasia at 3 weeks (65 %). These showed a significant difference in weight curves of a loss of 3.2 kg compared with gain of 5.2 kg in a control group. Four pigs died from anastomotic dehiscence complicated by peritonitis.

Conclusion: Gastrojejunal bypass with a pure NOTES approach is feasible. This procedure is effective, resulting in a patent anastomosis and a significant weight loss. However, the anastomotic dehiscence is a major concern because of its mortality rate, and further studies including improvement of the suturing device and the technique are needed.

 

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