title: Gastrojejunal anastomosis using a tissue-apposing stent: a safety and feasibility study in live pigs.
abstract: OBJECTIVE
  Various techniques using surgical and natural orifice transluminal endoscopic surgery (NOTES) have been evaluated to create a gastrojejunal bypass. The aim of the current study was to determine the safety, feasibility, and efficacy of a new technique using a pure endoscopic approach and tissue-apposing stent placement for gastrojejunal anastomosis (GJA).
  
  
  METHODS
  This was a prospective, experimental study on six live pigs weighing 20 - 45  kg. Endoscopies were performed using a double-channel gastroscope, and included the creation of a GJA using a tissue-apposing, fully covered, self-expanding metallic stent. Antibiotic therapy was continued for 7 days after the procedure, and food was gradually reintroduced from Day 3. Changes in weight following the procedure were compared with a control group of age-matched animals. Anastomosis functionality was confirmed by endoscopy at 3 weeks (before the animals were euthanized), and during histopathological analysis. The primary outcomes were morbidity and mortality at 3 weeks. Secondary outcomes were technical feasibility, procedure time, and patency of the GJA.
  
  
  RESULTS
  The procedures were performed successfully in all animals. The mean procedure time was 26  ±  6.7 minutes (range 15 - 32 minutes). One case of stent migration occurred during the procedure; the stent was successfully replaced using the same procedure. All animals were alive after 3 weeks. The mean weight gain during follow-up was 0.85  ±  2.56  kg (range - 2 to + 2  kg) compared with 5.2  ±  1.6  kg (range 3 - 7  kg) in control animals (P = 0.007). At necropsy, the stents were still in place in all animals, without evidence of peritonitis. Histopathology confirmed permeable anastomoses with continuity of the mucosa and mucosa muscle layers.
  
  
  CONCLUSIONS
  GJA with a tissue-apposing stent is safe, feasible, and reproducible without anastomotic leakage in a porcine model using a pure endoscopic approach and standard endoscopic equipment.
authors.affiliation: Endoscopie digestive, Hôpital L'Archet 2, Centre Hospitalier Universitaire, Nice, France.
authors.forename: Geoffroy
authors.initials: G
authors.lastname: Vanbiervliet
authors.affiliation: CERC, LBA UMRT24, Université Aix-Marseille, Faculté de médecine, Marseille, France.
authors.forename: Eduardo Aimore
authors.initials: EA
authors.lastname: Bonin
authors.affiliation: CERC, LBA UMRT24, Université Aix-Marseille, Faculté de médecine, Marseille, France.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Garcès
authors.affiliation: CERC, LBA UMRT24, Université Aix-Marseille, Faculté de médecine, Marseille, France.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Gonzalez
authors.affiliation: CERC, LBA UMRT24, Université Aix-Marseille, Faculté de médecine, Marseille, France.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Garnier
authors.affiliation: Département d'anatomo-pathologie, Hôpital Pasteur, Centre Hospitalier Universitaire, Nice, France.
authors.forename: Marie Christine Saint
authors.initials: MC
authors.lastname: Paul
authors.affiliation: CERC, LBA UMRT24, Université Aix-Marseille, Faculté de médecine, Marseille, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Berdah
authors.affiliation: CERC, LBA UMRT24, Université Aix-Marseille, Faculté de médecine, Marseille, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Barthet
mesh_terms: D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D000818:Animals; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005240:Feasibility Studies; D007583:Jejunum / Q000601:surgery*; D061646:Operative Time; D011446:Prospective Studies; D011475:Prosthesis Failure / Q000209:etiology; D015607:Stents / Q000009:adverse effects; D013270:Stomach / Q000601:surgery*; D013552:Swine; D015430:Weight Gain; D014945:Wound Healing