title: Percutaneous transgastric endoscopic tube ileostomy in a porcine survival model.
abstract: OBJECTIVE
  To introduce natural orifice transgastric endoscopic surgery (NOTES) tube ileostomy using pelvis-directed submucosal tunneling endoscopic gastrostomy and endoscopic tube ileostomy.
  
  
  METHODS
  Six live pigs (three each in the non-survival and survival groups) were used. A double-channeled therapeutic endoscope was introduced perorally into the stomach. A gastrostomy was made using a 2-cm transversal mucosal incision following the creation of a 5-cm longitudinal pelvis-directed submucosal tunnel. The pneumoperitoneum was establishedviathe endoscope. In the initial three operations of the series, a laparoscope was transumbilically inserted for guiding the tunnel direction, intraperitoneal spatial orientation and distal ileum identification. Endoscopic tube ileostomy was conducted by adopting an introducer method and using a Percutaneous Endoscopic Gastrostomy Catheter Kit equipped with the Loop Fixture. The distal tip of the 15 Fr catheter was placed toward the proximal limb of the ileum to optimize intestinal content drainage. Finally, the tunnel entrance of the gastrostomy was closed using nylon endoloops with the aid of a twin grasper. The gross and histopathological integrity of gastrostomy closure and the abdominal wall-ileum stoma tract formation were assessed 1 wk after the operation.
  
  
  RESULTS
  Transgastric endoscopic tube ileostomy was successful in all six pigs, without major bleeding. The mean operating time was 71 min (range: 60-110 min). There were no intraoperative complications or hemodynamic instability. The post-mortem, which was conducted 1-wk postoperatively, showed complete healing of the gastrostomy and adequate stoma tract formation of ileostomy.
  
  
  CONCLUSIONS
  Transgastric endoscopic tube ileostomy is technically feasible and reproducible in an animal model, and this technique is worthy of further improvement.
authors.affiliation: Hong Shi, Su-Yu Chen, Zhao-Fei Xie, Department of Gastrointestinal Endoscopy, Fujian Provincial Cancer Hospital, Affiliated Cancer Hospital of Fujian Medical University, Fuzhou 350014, Fujian Province, China.
authors.forename: Hong
authors.initials: H
authors.lastname: Shi
authors.affiliation: Hong Shi, Su-Yu Chen, Zhao-Fei Xie, Department of Gastrointestinal Endoscopy, Fujian Provincial Cancer Hospital, Affiliated Cancer Hospital of Fujian Medical University, Fuzhou 350014, Fujian Province, China.
authors.forename: Su-Yu
authors.initials: SY
authors.lastname: Chen
authors.affiliation: Hong Shi, Su-Yu Chen, Zhao-Fei Xie, Department of Gastrointestinal Endoscopy, Fujian Provincial Cancer Hospital, Affiliated Cancer Hospital of Fujian Medical University, Fuzhou 350014, Fujian Province, China.
authors.forename: Yong-Guang
authors.initials: YG
authors.lastname: Wang
authors.affiliation: Hong Shi, Su-Yu Chen, Zhao-Fei Xie, Department of Gastrointestinal Endoscopy, Fujian Provincial Cancer Hospital, Affiliated Cancer Hospital of Fujian Medical University, Fuzhou 350014, Fujian Province, China.
authors.forename: Sheng-Jun
authors.initials: SJ
authors.lastname: Jiang
authors.affiliation: Hong Shi, Su-Yu Chen, Zhao-Fei Xie, Department of Gastrointestinal Endoscopy, Fujian Provincial Cancer Hospital, Affiliated Cancer Hospital of Fujian Medical University, Fuzhou 350014, Fujian Province, China.
authors.forename: He-Li
authors.initials: HL
authors.lastname: Cai
authors.affiliation: Hong Shi, Su-Yu Chen, Zhao-Fei Xie, Department of Gastrointestinal Endoscopy, Fujian Provincial Cancer Hospital, Affiliated Cancer Hospital of Fujian Medical University, Fuzhou 350014, Fujian Province, China.
authors.forename: Kai
authors.initials: K
authors.lastname: Lin
authors.affiliation: Hong Shi, Su-Yu Chen, Zhao-Fei Xie, Department of Gastrointestinal Endoscopy, Fujian Provincial Cancer Hospital, Affiliated Cancer Hospital of Fujian Medical University, Fuzhou 350014, Fujian Province, China.
authors.forename: Zhao-Fei
authors.initials: ZF
authors.lastname: Xie
authors.affiliation: Hong Shi, Su-Yu Chen, Zhao-Fei Xie, Department of Gastrointestinal Endoscopy, Fujian Provincial Cancer Hospital, Affiliated Cancer Hospital of Fujian Medical University, Fuzhou 350014, Fujian Province, China.
authors.forename: Fen-Fang
authors.initials: FF
authors.lastname: Dong
mesh_terms: D000818:Animals; D019723:Endoscopes; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology; D005773:Gastroscopy / Q000379:methods*; D005774:Gastrostomy; D007081:Ileostomy; D020706:Laparoscopes; D023421:Models, Animal; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D011184:Postoperative Period; D013270:Stomach / Q000601:surgery; D034421:Sus scrofa; D013552:Swine
keywords: Endoloop; Natural orifice transluminal endoscopic surgery; Pigs; Submucosal tunneling; Tube ileostomy