title: Transluminal endosurgery: single lumen access anastomotic device for flexible endoscopy.
abstract: BACKGROUND
  Forming anastomoses between two hollow organs at flexible endoscopy might reduce the need for surgery for obstructing malignancy. Current methods require access to both lumens. The aim of this work was to develop methods of forming an anastomosis at flexible endoscopy, such as a gastrojejunostomy or cholecystoduodenostomy, when access to only one lumen is feasible.
  
  
  METHODS
  A modified needle was passed through a large-channel echoendoscope from the accessible lumen into the target hollow organ. An anastomotic device was formed by using two 7F catheter segments, which were pushed over a guidewire into the target, the less accessible lumen. When released, by withdrawing the guidewire, the catheters formed a cross shape and created an anastomosis when compressed against a plate from the accessible side.
  
  
  METHODS
  These devices were tested in live animal experiments. With an echoendoscope in the stomach, it was repeatedly possible to place needles, threaded tags, and guidewires into the small intestine and gallbladder. In 4 to 7 days, anastomoses were formed in 16 pigs between the small intestine and the stomach, and between the gallbladder and the stomach. The initial diameter of the anastomoses ranged from 3 to 9 mm. No complication occurred.
  
  
  CONCLUSIONS
  It is feasible to form anastomoses at flexible endoscopy when access is limited to a single side.
authors.affiliation: Academic Department of Gastroenterology, The Royal London Hospital, Whitechapel, United Kingdom.
authors.forename: Annette
authors.initials: A
authors.lastname: Fritscher-Ravens
authors.forename: C Alexander
authors.initials: CA
authors.lastname: Mosse
authors.forename: Dipankar
authors.initials: D
authors.lastname: Mukherjee
authors.forename: Tim
authors.initials: T
authors.lastname: Mills
authors.forename: Per-Ola
authors.initials: PO
authors.lastname: Park
authors.forename: C Paul
authors.initials: CP
authors.lastname: Swain
mesh_terms: D000714:Anastomosis, Surgical / Q000295:instrumentation*; D000818:Animals; D002404:Catheterization; D016145:Endoscopy, Digestive System; D004867:Equipment Design; D006801:Humans