Transgastric endoscopic gastrojejunostomy using holing followed by interrupted suture technique in a porcine model.
OBJECTIVE
To demonstrate the feasibility and reproducibility of a pure natural orifice transluminal endoscopic surgery (NOTES) gastrojejunostomy using holing followed by interrupted suture technique using a single endoloop matched with a pair of clips in a non-survival porcine model.


METHODS
NOTES gastrojejunostomy was performed on three female domestic pigs as follows: Gastrostomy, selection and retrieval of a free-floating loop of the small bowel into the stomach pouch, hold and exposure of the loop in the gastric cavity using a submucosal inflation technique, execution of a gastro-jejunal mucosal-seromuscular layer approximation using holing followed by interrupted suture technique with endoloop/clips, and full-thickness incision of the loop with a Dual knife.


RESULTS
Pure NOTES side-to-side gastrojejunostomy was successfully performed in all three animals. No leakage was identiﬁed via methylene blue evaluation following surgery.


CONCLUSIONS
This novel technique for preforming a gastrointestinal anastomosis exclusively by NOTES is technically feasible and reproducible in an animal model but warrants further improvement.
Su-Yu Chen, Hong Shi, Zhao-Fei Xie, Department of Gastrointestinal Endoscopy, Fujian Provincial Tumor Hospital, Teaching Hospital of Fujian Medical University, Fuzhou 350014, Fujian Province, China.
Su-Yu
SY
Chen
Su-Yu Chen, Hong Shi, Zhao-Fei Xie, Department of Gastrointestinal Endoscopy, Fujian Provincial Tumor Hospital, Teaching Hospital of Fujian Medical University, Fuzhou 350014, Fujian Province, China.
Hong
H
Shi
Su-Yu Chen, Hong Shi, Zhao-Fei Xie, Department of Gastrointestinal Endoscopy, Fujian Provincial Tumor Hospital, Teaching Hospital of Fujian Medical University, Fuzhou 350014, Fujian Province, China.
Sheng-Jun
SJ
Jiang
Su-Yu Chen, Hong Shi, Zhao-Fei Xie, Department of Gastrointestinal Endoscopy, Fujian Provincial Tumor Hospital, Teaching Hospital of Fujian Medical University, Fuzhou 350014, Fujian Province, China.
Yong-Guang
YG
Wang
Su-Yu Chen, Hong Shi, Zhao-Fei Xie, Department of Gastrointestinal Endoscopy, Fujian Provincial Tumor Hospital, Teaching Hospital of Fujian Medical University, Fuzhou 350014, Fujian Province, China.
Kai
K
Lin
Su-Yu Chen, Hong Shi, Zhao-Fei Xie, Department of Gastrointestinal Endoscopy, Fujian Provincial Tumor Hospital, Teaching Hospital of Fujian Medical University, Fuzhou 350014, Fujian Province, China.
Zhao-Fei
ZF
Xie
Su-Yu Chen, Hong Shi, Zhao-Fei Xie, Department of Gastrointestinal Endoscopy, Fujian Provincial Tumor Hospital, Teaching Hospital of Fujian Medical University, Fuzhou 350014, Fujian Province, China.
Xiao-Jing
XJ
Liu
Endoloop; Endoscopic clips; Endoscopic gastrojejunostomy; Natural orifice transluminal endoscopic surgery; Pigs