Transgastric anastomosis by using flexible endoscopy in a porcine model (with video)

Background: Transgastric flexible endoscopic anastomosis might offer advantages over open and laparoscopic surgery, especially for bariatrics or patients with obstructive malignancy. Objective: To develop methods for performing transgastric anastomosis. Design/results: Twelve gastrojejunal anastomoses were formed in pigs weighing 27 kg to 38 kg (6 each in survival and nonsurvival groups) by using a per-oral double-channel gastroscope. The stomach was penetrated with a needle-knife guidewire combination and bow-sphincterotome incision. The small intestine (SI) was grasped with a snare-over-forceps method and pulled into the stomach for suturing. Sutures were placed in pairs through the deep muscle of the stomach and small intestine to join the tissues securely The SI was incised with a needle-knife to open the anastomosis. Anastomoses were placed close to the cardioesophageal junction for bariatric purposes or in the antrum for pancreatic bypass. Survival Studies in 6 pigs showed anastomosis patency at 7 to 10 days. Conclusion: Gastrojejunal anastomosis was accomplished via the transgastric route by using a new double-channel endoscopic method.