Endoscopic gastrojejunostomy with survival in a porcine model.
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 A loop of jejunum was identified, was retracted into the stomach, and was secured with sutures while using a prototype endoscopic suturing device.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.
Kantsevoy
Sergey V
SV
Division of Gastronenterology, Johns Hopkins Hospital, Baltimore, MD 21205, USA.
Jagannath
Sanjay B
SB
Niiyama
Hideaki
H
Chung
Sydney S C
SS
Cotton
Peter B
PB
Gostout
Christopher J
CJ
Hawes
Robert H
RH
Pasricha
Pankaj J
PJ
Magee
Carolyn A
CA
Vaughn
Cheryl A
CA
Barlow
David
D
Shimonaka
Hideki
H
Kalloo
Anthony N
AN
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