title: Transgastric endoscopic gastroenterostomy using a partially covered occluder: a canine feasibility study.
abstract: OBJECTIVE
  The use of natural oriﬁce transluminal endoscopic surgery (NOTES) for gastroenterostomy has been previously reported, but it remains technically challenging and additional assistance is often needed. The aim of this study was to develop and evaluate a novel method for the creation of a gastroenterostomy using NOTES with an occluder.
  
  
  METHODS
  Transgastric endoscopic gastroenterostomy was performed in 12 healthy female dogs using a therapeutic upper gastrointestinal endoscope and a partially covered occluder. The occluder was removed with a snare 1 week later. The patency of the gastroenterostomy was confirmed by endoscopy, contrast radiological study, necropsy, and histological examination after 2 weeks.
  
  
  RESULTS
  NOTES gastroenterostomy with an occluder was successful in all 12 dogs. The mean operative time was 32.3 ± 10.3 min (range 20.3 - 53.5). One dog (the first; 8.3 %) died 4 days after the operation of severe intra-abdominal infection due to incorrect deployment of the occluder and poor bowel preparation. Minor bleeding occurred at the anastomosis after removal of the occluder in two of the remaining dogs (18.2 %). Necropsy revealed postoperative adhesions that had developed at the anastomotic site in one dog (9.1 %). No anastomotic leakage or intestinal obstruction was observed. Complete healing of the anastomosis was confirmed on histological evaluation.
  
  
  CONCLUSIONS
  Gastroenterostomy performed entirely by NOTES using an occluder was technically feasible in this survival animal model.
authors.affiliation: Department of Gastroenterology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
authors.forename: H
authors.initials: H
authors.lastname: Luo
authors.forename: Y
authors.initials: Y
authors.lastname: Pan
authors.forename: L
authors.initials: L
authors.lastname: Min
authors.forename: L
authors.initials: L
authors.lastname: Zhao
authors.forename: J
authors.initials: J
authors.lastname: Li
authors.forename: J
authors.initials: J
authors.lastname: Leung
authors.forename: L
authors.initials: L
authors.lastname: Xue
authors.forename: Z
authors.initials: Z
authors.lastname: Yin
authors.forename: X
authors.initials: X
authors.lastname: Liu
authors.forename: Z
authors.initials: Z
authors.lastname: Liu
authors.forename: A
authors.initials: A
authors.lastname: Sun
authors.forename: C
authors.initials: C
authors.lastname: Li
authors.forename: K
authors.initials: K
authors.lastname: Wu
authors.forename: X
authors.initials: X
authors.lastname: Guo
authors.forename: D
authors.initials: D
authors.lastname: Fan
mesh_terms: D000818:Animals; D004285:Dogs; D020776:Endoscopes, Gastrointestinal; D005240:Feasibility Studies; D005260:Female; D005763:Gastroenterostomy / Q000295:instrumentation* / Q000379:methods; D057605:Natural Orifice Endoscopic Surgery / Q000295:instrumentation / Q000379:methods*