Increased postprandial glucagon-like peptide-1 (GLP-1) production after endoscopic gastrointestinal bypass using the Cousin lumen-apposing stent in a porcine model

Abstract

Background and study aims Endoscopic techniques have demonstrated their effectiveness in metabolic surgery, notably through a gastrointestinal (GI) liner, with a less invasive approach than conventional surgery. Our study evaluates the safety and efficacy of endoscopic GI anastomosis (EGIA) using a lumen-apposing stent to secure the anastomosis.

Materials and methods EGIA was performed using the transgastric approach with a two-channel endoscope with a novel stent (Cousin Biotech). First, a safety study with a follow-up of 12 months was performed on five piglets. Then, metabolic changes were investigated in a minipig model (n = 10) before and after EGIA or open GIA (OGIA).

Results EGIA was technically successful with no complications observed during clinical monitoring. Endoscopic and postmortem examinations during the second part of study showed a secure anastomosis between the stomach and the intestinal limb in all except one minipig. Both minipigs subjected to EGIA and those in the control group (OGIA) exhibited increased postprandial glucagon-like peptide-1 (GLP-1) production (incretin secretion) and impaired D-xylose absorption (malabsorption effect).

Conclusion Performing EGIA with this dedicated stent appears safe, technically feasible, durable, and reproducible in providing a simple and effective endoscopic GI bypass capable of ensuring metabolic effect.

• References

• 1 Seeley RJ, Chambers AP, Sandoval DA. The role of gut adaptation in the potent effects of multiple bariatric surgeries on obesity and diabetes. Cell Metab 2015; 21: 369-378
• 2 Baud G, Daoudi M, Hubert T. et al. Bile diversion in Roux-en-Y gastric bypass modulates sodium-dependent glucose intestinal uptake. Cell Metab 2016; 23: 547-553
• 3 Schouten R, Rijs CS, Bouvy ND. et al. A multicenter, randomized efficacy study of the EndoBarrier Gastrointestinal Liner for presurgical weight loss prior to bariatric surgery. Ann Surg 2010; 251: 236-243
• 4 Swain P. NOTES and anastomosis. Gastrointest Endosc Clin N Am 2008; 18: 261-277 ; viii
• 5 Auyang ED, Hungness ES, Vaziri K. et al. Human NOTES cholecystectomy: transgastric hybrid technique. J Gastrointest Surg 2009; 13: 1149-1150
• 6 Kantsevoy SV, Jagannath SB, Niiyama H. et al. Endoscopic gastrojejunostomy with survival in a porcine model. Gastrointest Endosc 2005; 62: 287-292
• 7 Vanbiervliet G, Bonin EA, Garces R. et al. Gastrojejunal anastomosis using a tissue-apposing stent: a safety and feasibility study in live pigs. Endoscopy 2014; 46: 871-877
• 8 Vanbiervliet G, Gonzalez JM, Bonin EA. et al. Gastrojejunal anastomosis exclusively using the “NOTES” technique in live pigs: a feasibility and reliability study. Surg Innov 2014; 21: 409-418
• 9 Barthet M, Binmoeller KF, Vanbiervliet 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
• 10 Verhaeghe R, Zerrweck C, Hubert T. et al. Gastric bypass increases postprandial insulin and GLP-1 in nonobese minipigs. Eur Surg Res 2014; 52: 41-49
• 11 Eberts TJ, Sample RH, Glick MR. et al. A simplified, colorimetric micromethod for xylose in serum or urine, with phloroglucinol. Clin Chem 1979; 25: 1440-1443
• 12 le Roux CW, Aylwin SJ, Batterham RL. et al. Gut hormone profiles following bariatric surgery favor an anorectic state, facilitate weight loss, and improve metabolic parameters. Ann Surg 2006; 243: 108-114
• 13 Gonzalez JM, Bonin EA, Vanbiervliet G. et al. Evaluation of feasibility, efficiency and safety of a pure NOTES gastrojejunal bypass with gastric outlet obstruction, in an in vivo porcine model. Endosc Int Open 2013; 1: 31-38
• 14 van Hooft JE, Vleggaar FP, Le Moine O. et al. Endoscopic magnetic gastroenteric anastomosis for palliation of malignant gastric outlet obstruction: a prospective multicenter study. Gastrointest Endosc 2010; 72: 530-535
• 15 Binmoeller KF, Shah JN. Endoscopic ultrasound-guided gastroenterostomy using novel tools designed for transluminal therapy: a porcine study. Endoscopy 2012; 44: 499-503
• 16 Itoi T, Itokawa F, Uraoka T. et al. Novel EUS-guided gastrojejunostomy technique using a new double-balloon enteric tube and lumen-apposing metal stent (with videos). Gastrointest Endosc 2013; 78: 934-939
• 17 Nergaard BJ, Leifsson BG, Hedenbro J. et al. Gastric bypass with long alimentary limb or long pancreato-biliary limb--long-term results on weight loss, resolution of co-morbidities and metabolic parameters. Obes Surg 2014; 24: 1595-1602
• 18 Shabalovskaya SA, Anderegg JW, Undisz A. et al. Corrosion resistance, chemistry, and mechanical aspects of Nitinol surfaces formed in hydrogen peroxide solutions. J Biomed Mater Res B 2012; 100: 1490-1499
• 19 Rubino F, Forgione A, Cummings DE. et al. The mechanism of diabetes control after gastrointestinal bypass surgery reveals a role of the proximal small intestine in the pathophysiology of type 2 diabetes. Ann Surg 2006; 244: 741-749