title: Endoscopic transgastric lymphadenectomy by using EUS for selection and guidance.
abstract: BACKGROUND
  EUS-guided fine needle aspiration (EUS-FNA) is a reliable tool for tissue diagnosis of unexplained mediastinal or perigastric lymphadenopathy but may be ineffective in sampling a small malignant focus in it or removing an entire node.
  
  
  OBJECTIVE
  To develop a new EUS-guided endoscopic-transgastric method to approach (sentinel) lymph nodes, including node marking and lymphadenectomy.
  
  
  METHODS
  Experimental study.
  
  
  METHODS
  Animal experiments at an approved university college.
  
  
  METHODS
  Six pigs had a linear-array EUS examination 1 week after a transgastric procedure. All had reactive perigastric lymph nodes.
  
  
  METHODS
  Selected nodes were punctured with a 19-gauge EUS needle. A metal anchor with thread, loaded onto the needle, was placed across the lymph nodes to pull the node toward the stomach. After gastric-wall dissection with a needle knife at the point of emergence of the thread, the nodes were removed by pulling on the thread and the anchor. The gastric incision was closed with an endoscopic suturing system.
  
  
  METHODS
  Proof of the feasibility to endoscopically remove paragastric lymph nodes by an EUS-guided transgastric approach.
  
  
  RESULTS
  In all pigs, lymph-node marking with an anchor and thread was possible. Traction exerted on these nodes showed that they could be pulled against the gastric wall for subsequent removal. In 2 of 6 examinations, the entire sequence of the procedure, node tagging, gastric-wall incision, lymphadenectomy, and wall closure was performed. No serious complication occurred.
  
  
  CONCLUSIONS
  Animal study throughout, small numbers, no humans to date.
  
  
  CONCLUSIONS
  Transgastric lymphadenectomy with EUS for node selection and capturing seems feasible.
authors.affiliation: Department of Gastroenterology, Homerton University Hospital, University College, London, UK.
authors.forename: Annette
authors.initials: A
authors.lastname: Fritscher-Ravens
authors.forename: C Alexander
authors.initials: CA
authors.lastname: Mosse
authors.forename: Keiichi
authors.initials: K
authors.lastname: Ikeda
authors.forename: Paul
authors.initials: P
authors.lastname: Swain
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D019160:Endosonography; D005240:Feasibility Studies; D005773:Gastroscopy; D008197:Lymph Node Excision / Q000379:methods*; D008206:Lymphatic Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D013270:Stomach; D013552:Swine