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CC BY-NC-ND 4.0 · Endosc Int Open 2022; 10(11): E1508-E1513
DOI: 10.1055/a-1933-6573
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Use of an intragastric trocar to perform a novel stapling procedure for reflux disease

Andrew C. Storm
1   Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
2   Developmental Endoscopy Unit, Mayo Clinic, Rochester, Minnesota, United States
,
Jad P. AbiMansour
1   Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
,
Aliana Bofill-Garcia
1   Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
,
Tala Mahmoud
1   Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
,
Babusai Rapaka
1   Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
,
Kristin E. Lescalleet
1   Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
,
Barham K. Abu Dayyeh
1   Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
› Author AffiliationsSupported by: endo-TAGSS, LLC
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Abstract

Background and study aims A percutaneous intragastric trocar (PIT) enables intraluminal use of laparoscopic tools and helps overcome traditional limitations of endoscopy. The aim of this study was to determine the efficacy of using a PIT to perform an anti-reflux stapling procedure.

Materials and methods Trocars were placed in four animals and an articulating stapler was used to perform fundoplication under endoscopic guidance. Animals were monitored for 14 days post-procedure. Functional lumen imaging of the esophagogastric junction (EGJ) was performed at baseline, immediately post-intervention, and at 14 days.

Results The procedure was successful in all animals who survived to day 14 without distress or significant adverse events. Baseline EGJ distensibility was 5.0 ± 1.2 mm2/mmHg, 2.7 ± 0.7 mm2/mmHg post-procedurally, and 3.0 ± 0.8mm2/mmHg on day 14. Average change in distensibility pre- and post-procedure was –2.3 ± 1.8 mm2/mmHg (95 % confidence interval [CI] –0.5 to 5.1, P = 0.08) while change in pre- and day 14 distensibility was –2.0 ± 1.4 mm2/mmHg (95 % CI –0.1 to 4.2, P = 0.06).

Conclusions An intragastric trocar allows for use of large-diameter laparoscopic instruments to safely and effectively perform endoluminal fundoplication with anti-reflux properties that persist for at least 14 days.



Publication History

Received: 04 May 2022

Accepted after revision: 25 August 2022

Accepted Manuscript online:
30 August 2022

Article published online:
15 November 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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