title: Natural orifice transluminal endoscopic surgery gastroenterostomy with a biflanged lumen-apposing stent: first clinical experience (with videos).
abstract: BACKGROUND
  We established feasibility and safety for natural orifice transluminal endoscopic surgery (NOTES) GI anastomosis with a lumen-apposing stent in live pigs. This approach was performed in 3 patients.
  
  
  OBJECTIVE
  Creation of a NOTES gastroduodenal anastomosis in patients.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Two tertiary-care referral centers at large academic hospitals in France and in the United States.
  
  
  METHODS
  Patients with refractory benign duodenal stenosis and malignant duodenal obstruction.
  
  
  METHODS
  NOTES GI anastomosis with a lumen-apposing stent.
  
  
  METHODS
  Disappearence of gastric outlet obstruction.
  
  
  RESULTS
  All 3 procedures were technically successful and uneventful, except 1 minor adverse event. There were no instances of stent occlusion or migration during follow-up. All patients resumed a normal diet.
  
  
  CONCLUSIONS
  Small case series.
  
  
  CONCLUSIONS
  NOTES gastroenteric anastomosis is feasible and safe in humans. A prospective pilot study is warranted.
authors.affiliation: Faculty of Medicine, Aix-Marseille University, Marseille, France; Gastroenterology, Public Assistance Hospitals of Marseille, Marseille, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Barthet
authors.affiliation: Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, California, USA.
authors.forename: Kenneth F
authors.initials: KF
authors.lastname: Binmoeller
authors.affiliation: Faculty of Medicine, Aix-Marseille University, Marseille, France; Gastroenterology, University Hospital of Nice, Nice, France.
authors.forename: Geoffroy
authors.initials: G
authors.lastname: Vanbiervliet
authors.affiliation: Faculty of Medicine, Aix-Marseille University, Marseille, France; Gastroenterology, Public Assistance Hospitals of Marseille, Marseille, France.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Gonzalez
authors.affiliation: Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA.
authors.forename: Todd H
authors.initials: TH
authors.lastname: Baron
authors.affiliation: Faculty of Medicine, Aix-Marseille University, Marseille, France; Gastroenterology, Public Assistance Hospitals of Marseille, Marseille, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Berdah
mesh_terms: D000230:Adenocarcinoma / Q000150:complications*; D000328:Adult; D000368:Aged; D004380:Duodenal Obstruction / Q000209:etiology / Q000601:surgery*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D007409:Intestinal Atresia; D008297:Male; D057605:Natural Orifice Endoscopic Surgery; D010190:Pancreatic Neoplasms / Q000150:complications*