Endoscopic transgastric lymphadenectomy by using EUS for selection and guidance.
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.
Fritscher-Ravens
Annette
A
Department of Gastroenterology, Homerton University Hospital, University College, London, UK.
Mosse
C Alexander
CA
Ikeda
Keiichi
K
Swain
Paul
P
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