title: EUS assisted transmural cholecystogastrostomy fistula creation as a bridge for endoscopic internal gallbladder therapy using a novel fully covered metal stent.
abstract: BACKGROUND
  Laparoscopic cholecystectomy (LC) has become the "gold standard" for treating symptomatic gallstones. Innovative methods, such as a scarless therapeutic procedure through a natural orifice are being introduced, and include transgastric or transcolonic endoscopic cholecystectomy. However, before clinical implementation, instruments still need modification, and a more convenient treatment is still needed. The aim of this study was to evaluate the feasibility of endoscopic internal gallbladder therapy such as cholecystolithotomy in an animal survival model.
  
  
  METHODS
  Four pigs underwent endoscopic-ultrasound (EUS)-guided cholecystogastrostomy and the placement of a novel covered mental stent. Four weeks later the stents were removed and an endoscope was advanced into the gallbladder via the fistula, and cholecystolithotomy was performed. Two weeks later the pigs were sacrificed, and the healing of the fistulas was assessed.
  
  
  RESULTS
  EUS-guided cholecystogastrostomy with mental stent deployment was successfully performed in all the animals. Four weeks after the procedure, the fistulas had formed and all the stents were removed. Endoscopic cholecystolithotomy was performed through each fistula. All the animals survived until they were sacrificed 2 weeks later. The fistulas were found to be completely healed.
  
  
  CONCLUSIONS
  This study reports the first endoscopic transmural cholecystolithotomy after placement of a novel mental stent in an animal survival model.
authors.forename: Nan
authors.initials: N
authors.lastname: Ge
authors.forename: Zhiguo
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Endoscopy center, Shengjing Hospital, Shenyang, China. sun-siyu@163.com.
authors.forename: Siyu
authors.initials: S
authors.lastname: Sun
authors.forename: Sheng
authors.initials: S
authors.lastname: Wang
authors.forename: Guoxin
authors.initials: G
authors.lastname: Wang
authors.forename: Shiwei
authors.initials: S
authors.lastname: Sun
authors.forename: Linlin
authors.initials: L
authors.lastname: Feng
authors.forename: Fei
authors.initials: F
authors.lastname: Yang
authors.forename: Wenzhuang
authors.initials: W
authors.lastname: Ma
authors.forename: Shupeng
authors.initials: S
authors.lastname: Wang
authors.forename: Xiang
authors.initials: X
authors.lastname: Liu
authors.forename: Jintao
authors.initials: J
authors.lastname: Guo
authors.forename: Wen
authors.initials: W
authors.lastname: Liu
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D000818:Animals; D002767:Cholecystostomy / Q000379:methods; D016145:Endoscopy, Digestive System / Q000379:methods; D019160:Endosonography / Q000379:methods; D005240:Feasibility Studies; D005704:Gallbladder / Q000601:surgery*; D042882:Gallstones / Q000601:surgery*; D005774:Gastrostomy / Q000379:methods; D015607:Stents; D013270:Stomach / Q000601:surgery*; D013552:Swine