RSS-Feed abonnieren
DOI: 10.1055/a-2085-3866
Ultrasound Assisted Endoscopic Gastric Bypass (USA-EGB): a potential endoscopic alternative to surgical bypass, a pre-clinical proof of concept study
Abstract
Background and study aims Endoscopic weight loss procedures have gained traction as minimally invasive options for the primary treatment of obesity. Thus far, we have developed endoscopic procedures that reliably address gastric restriction but result in significantly less weight loss than surgical gastrointestinal bypass. The goal of this nonsurvival study was to assess the technical feasibility of an endoscopic procedure, that incorporates both gastric restriction and potentially reversible gastrointestinal bypass.
Methods Ultrasound-assisted endoscopic gastric bypass (USA-EGB) was performed in three consecutive live swine, followed by euthanasia and necropsy. Procedure steps were: 1) balloon-assisted enteroscopy that determines the length of the bypassed limb; 2) endoscopic ultrasound-guided gastroenterostomy that creates a gastrointestinal anastomosis using a lumen apposing metal stent; 3) endoscopic pyloric exclusion that disrupts transpyloric continuity resulting in complete gastrointestinal bypass; and 4) gastric restriction that reduces gastric volume.
Results Complete gastrointestinal bypass and gastric restriction was achieved in all three swine. The mean total procedure time was 131 minutes (range 113–143), mean length of the bypassed limb was 92.5 cm and 180 cm, using short and long overtubes, respectively. There were no significant complications.
Conclusions We successfully described USA-EGB in three consecutive live swine. Further studies are needed to access the procedures safety, efficacy, and clinical use.
Publikationsverlauf
Eingereicht: 12. Februar 2023
Angenommen nach Revision: 27. April 2023
Accepted Manuscript online:
03. Mai 2023
Artikel online veröffentlicht:
21. Juni 2023
© 2023. 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/).
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 Ward ZJ, Bleich SN, Cardock AL. et al. Projected U.S. state-level prevalence of adult obesity and severe obesity. N Engl J Med 2019; 381: 2440-2450
- 2 Dobbs R. et al. Overcoming obesity: an initial economic analysis. McKinsey global institute; 2014
- 3 Ward ZJ, Bleich SN, Long MW. et al. Association of body mass index with health care expenditures in the United States by age and sex. Plos One 2021; 16: e0247307
- 4 Wadden TA, Webb VL, Moran CL. et al. Lifestyle modification for obesity: new developments in diet, physical activity, and behavior therapy. Circulation 2012; 125: 1157-1170
- 5 Shi Q, Wang Y, Hao QH. et al. Pharmacotherapy for adults with overweight and obesity: a systematic review and network meta-analysis of randomised controlled trials. Lancet 2022; 399: 259-269
- 6 Kohn GP, Galanko JA, Overby DW. et al. Recent trends in bariatric surgery case volume in the United States. Surgery 2009; 146: 375-380
- 7 Pickett-Blakely OE, Huizinga MM, Clark JM. et al. Sociodemographic trends in bariatric surgery utilization in the USA. Obesity Surgery 2012; 22: 838-842
- 8 Fung M, Wharton S, Macpherson A. et al. Receptivity to bariatric surgery in qualified patients. J Obesity 2016; 2016: 5372190
- 9 Wharto S, Serodio KJ, Sivapalan N. et al. Interest, views and perceived barriers to bariatric surgery in patients with morbid obesity. Clin Obes 2016; 6: 154-160
- 10 Uhe I, Douissard J, Podetta M. et al. Roux-en-Y gastric bypass, sleeve gastrectomy, or one-anastomosis gastric bypass? A systematic review and meta-analysis of randomized-controlled trials. Obesity (Silver Spring) 2022; 30: 614-627
- 11 Khaitan L, Shea B. et al. Current and future endoscopic weight loss solutions. techniques in vascular and interventional radiology 2020; 23: 100655
- 12 Gloy VL, Matthias B, Bhatt DL. et al. Bariatric surgery versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomised controlled trials. BMJ 2013; 347: 5934
- 13 Heymsfield SB, Wadden TA. Mechanisms, pathophysiology, and management of obesity. N Engl J Med 2017; 376: 254-266
- 14 Gonzalez JM, Ouazzani S, Berdah S. et al. Feasibility of a new bariatric fully endoscopic duodeenal-jejunal bypass: a pilot study in adult obese pigs. Sci Rep 2022; 12: 202-275
- 15 Barthet M, Binmoeller KF, Vanbiervlietm G. et al. Natural orifice transluminal endoscopic surgery gastroenterostomy with a biflanged lumen-apposing stent: first clinical experience (with videos). Gastrointest Endosc 2015; 81: 215-218
- 16 Lee CL, Lium HM, Khan S. et al. Vaginal natural orifice transvaginal endoscopic surgery (vNOTES) surgical staging for endometrial carcinoma: The feasibility of an innovative approach. Taiwan J Obstet Gynecol 2022; 61: 345-352
- 17 Haddad A, Bashir A, Fobi M. et al. The IFSO Worldwide One Anastomosis Gastric Bypass Survey: Techniques and Outcomes?. Obes Surg 2021; 31: 1411-1421
- 18 Betés M, Perez-Longo P, Peralta S. et al. Feasibility and patency of echoendoscopic anastomoses with lumen apposing metal stents depending on the gastrointestinal segment involved. Sci Rep 2021; 11: 3992
- 19 Kerdsirichairat T, Irani S, Yang J. et al. Durability and long-term outcomes of direct EUS-guided gastroenterostomy using lumen-apposing metal stents for gastric outlet obstruction. Endosc Int Open 2019; 7: E144-E150
- 20 Kadkhodayan K, Hussain A, Khan H. et al. Endoscopic pyloric exclusion-EUS-guided gastrojejunostomy combined with endoscopic suturing and closure of the pylorus: a novel approach to failed surgical repair of a perforated duodenal ulcer. VideoGIE 2023; 8: 121-123