Basic Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Oct 25, 2015; 7(15): 1186-1190
Published online Oct 25, 2015. doi: 10.4253/wjge.v7.i15.1186
Transgastric endoscopic gastrojejunostomy using holing followed by interrupted suture technique in a porcine model
Su-Yu Chen, Hong Shi, Sheng-Jun Jiang, Yong-Guang Wang, Kai Lin, Zhao-Fei Xie, Xiao-Jing Liu
Su-Yu Chen, Hong Shi, Zhao-Fei Xie, Department of Gastrointestinal Endoscopy, Fujian Provincial Tumor Hospital, Teaching Hospital of Fujian Medical University, Fuzhou 350014, Fujian Province, China
Sheng-Jun Jiang, Yong-Guang Wang, Xiao-Jing Liu, Department of Minimally Invasive Surgery, Beijing Chuiyangliu Hospital, Institute of Minimally Invasive Medicine of Tongji University, Beijing 100022, China
Kai Lin, Department of General Surgery, Fuzhou Seventh Hospital, Fuzhou 350014, Fujian Province, China
Author contributions: Chen SY and Shi H were responsible for the study conception and design, and endoscopic procedures; all authors preformed the endoscopic procedures together; Chen SY drafted the manuscript; Shi H and Wang YG revised and finalized the manuscript; all the authors contribute to the manuscript.
Supported by Medical Innovation Project of Fujian Provincial Health Bureau (2012-C*B-8).
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Fujian Provincial Tumor Hospital, Teaching Hospital of Fujian Medical University.
Institutional animal care and use committee statement: All procedures involving animals were reviewed and approved by the Institutional Animal Care and Use Committee of Fujian Provincial Tumor Hospital, Teaching Hospital of Fujian Medical University( protocol number: 2012-C*B-8).
Conflict-of-interest statement: To the best of our knowledge, no conflicts of interest exist regarding the publication of this manuscript.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hong Shi, MD, Department of Gastrointestinal Endoscopy, Fujian Provincial Tumor Hospital, Teaching Hospital of Fujian Medical University, No. 420 FuMa Road, Fuzhou 350014, Fujian Province, China. endoshihong@hotmail.com
Telephone: +86-591-83660063 Fax: +86-591-83660063
Received: June 25, 2015
Peer-review started: June 27, 2015
First decision: July 10, 2015
Revised: July 26, 2015
Accepted: September 13, 2015
Article in press: September 21, 2015
Published online: October 25, 2015
Processing time: 118 Days and 18.2 Hours
Abstract

AIM: To demonstrate the feasibility and reproducibility of a pure natural orifice transluminal endoscopic surgery (NOTES) gastrojejunostomy using holing followed by interrupted suture technique using a single endoloop matched with a pair of clips in a non-survival porcine model.

METHODS: NOTES gastrojejunostomy was performed on three female domestic pigs as follows: Gastrostomy, selection and retrieval of a free-floating loop of the small bowel into the stomach pouch, hold and exposure of the loop in the gastric cavity using a submucosal inflation technique, execution of a gastro-jejunal mucosal-seromuscular layer approximation using holing followed by interrupted suture technique with endoloop/clips, and full-thickness incision of the loop with a Dual knife.

RESULTS: Pure NOTES side-to-side gastrojejunostomy was successfully performed in all three animals. No leakage was identified via methylene blue evaluation following surgery.

CONCLUSION: This novel technique for preforming a gastrointestinal anastomosis exclusively by NOTES is technically feasible and reproducible in an animal model but warrants further improvement.

Keywords: Endoscopic gastrojejunostomy; Endoloop; Endoscopic clips; Natural orifice transluminal endoscopic surgery; Pigs

Core tip: A pure natural orifice transluminal endoscopic surgery gastrojejunostomy procedure may be successfully performed in a non-survival porcine model using holing followed by interrupted suture technique using one endoloop matched with a pair of clips, without the need of any additional devices.