title: Endoscopic gastrojejunostomy with survival in a porcine model.
abstract: BACKGROUND
  We have previously reported the feasibility and the safety of an endoscopic transgastric approach to the peritoneal cavity in a porcine model. We now report successful performance of endoscopic gastrojejunostomy with survival.
  
  
  METHODS
  All procedures were performed on 50-kg pigs, with the pigs under general anesthesia, in aseptic conditions with sterilized endoscopes and accessories. The stomach was irrigated with antibiotic solution, and a gastric incision was performed with a needle-knife and a sphincterotome. A standard upper endoscope was advanced through a sterile overtube into the peritoneal cavity. A loop of jejunum was identified, was retracted into the stomach, and was secured with sutures while using a prototype endoscopic suturing device. An incision was made into the jejunal loop with a needle-knife, and the filet-opened ends of the jejunal wall were secured to the gastric wall with a second line of sutures, completing the gastrojejunostomy.
  
  
  METHODS
  Two pigs survived for 2 weeks. Endoscopy and a radiographic contrast study performed after gastrojejunostomy revealed a patent anastomosis with normal-appearing gastric and jejunal mucosa. Postmortem examination demonstrated a well-healed anastomosis without infection or adhesions.
  
  
  CONCLUSIONS
  The endoscopic transgastric approach to create a gastrojejunostomy is technically feasible and can be performed, with survival, in a porcine model.
authors.affiliation: Division of Gastronenterology, Johns Hopkins Hospital, Baltimore, MD 21205, USA.
authors.forename: Sergey V
authors.initials: SV
authors.lastname: Kantsevoy
authors.forename: Sanjay B
authors.initials: SB
authors.lastname: Jagannath
authors.forename: Hideaki
authors.initials: H
authors.lastname: Niiyama
authors.forename: Sydney S C
authors.initials: SS
authors.lastname: Chung
authors.forename: Peter B
authors.initials: PB
authors.lastname: Cotton
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Gostout
authors.forename: Robert H
authors.initials: RH
authors.lastname: Hawes
authors.forename: Pankaj J
authors.initials: PJ
authors.lastname: Pasricha
authors.forename: Carolyn A
authors.initials: CA
authors.lastname: Magee
authors.forename: Cheryl A
authors.initials: CA
authors.lastname: Vaughn
authors.forename: David
authors.initials: D
authors.lastname: Barlow
authors.forename: Hideki
authors.initials: H
authors.lastname: Shimonaka
authors.forename: Anthony N
authors.initials: AN
authors.lastname: Kalloo
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005240:Feasibility Studies; D005774:Gastrostomy / Q000379:methods* / Q000401:mortality; D007582:Jejunostomy / Q000379:methods* / Q000401:mortality; D012449:Safety; D013552:Swine