Gastrojejunal anastomosis using a tissue-apposing stent: a safety and feasibility study in live pigs

Vanbiervliet, Geoffroy; Bonin, Eduardo A.; GarcèS, Rodrigo; Gonzalez, Jean‐Michel; Garnier, Emmanuelle; Paul, M.C. Saint; Berdah, Stéphane; Barthet, Marc

doi:10.1055/s-0034-1377347

Cited by 18 publications

(21 citation statements)

References 20 publications

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“…The feasibility of LAMS gastrojejunostomy first emerged in the literature in animal studies that used either EUS-based 5 6 or NOTES-based approaches 7 8 . Subsequently, in several additional case reports 9 10 11 12 and two case series 13 14 , EUS-GJ appeared safe and efficacious in humans.…”

Section: Discussionmentioning

confidence: 99%

“…This procedure involves locating the jejunum endosonographically from inside the stomach and placing a dedicated biflanged lumen-apposing metal stent (LAMS) across a newly formed fistulous tract. EUS-GJ has been validated in animal models 5 6 7 8 , several case reports 9 10 11 12 , and two case series to date 13 14 . We present an international, multicenter experience that aimed to further assess the efficacy and safety of EUS-GJ in patients having GOO with both benign and malignant causes.…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic ultrasound-guided gastrojejunostomy with a lumen-apposing metal stent: a multicenter, international experience

et al. 2016

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Background: Surgical gastrojejunostomy and enteral self-expanding metal stents are efficacious for the management of gastric outlet obstruction but limited by high complication rates and short-term efficacy. Endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ) is a novel alternative option. Patients and methods: Patients who underwent EUS-GJ between March 2014 and September 2015 as part of a prospective multicenter registry at four academic centers in two countries were included. Technical success was defined as successful placement of a gastrojejunal lumen-apposing metal stent. Clinical success was defined as the ability of the patient to tolerate an oral diet. Post-procedural adverse events were recorded. Results: The study included 26 patients, of whom 11 (42 %) were male. Technical success was achieved in 24 patients (92 %). Clinical success was achieved in 22 patients (85 %). Of the 4 patients in whom clinical success was not achieved, 2 had persistent nausea and vomiting despite a patent EUS-GJ and required enteral feeding for nutrition, 1 died before the initiation of an oral diet, and 1 underwent surgery for suspected perforation. Adverse events, including peritonitis, bleeding, and surgery, occurred in 3 patients (11.5 %). Conclusion: EUS-GJ is an emerging procedure that has efficacy and safety comparable with those of current therapies and should hold a place as a new minimally invasive option for patients with gastric outlet obstruction.Clinical trial identification number: NCT01522573

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Endoscopic ultrasound-guided gastrojejunostomy with a lumen-apposing metal stent: a multicenter, international experience

et al. 2016

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“…It can be used across the desired anastomotic site to hold tissue layers in apposition. Our results in pure NOTES gastrojejunal anastomosis using this device have shown a constant technical success with a significant reduced mean operative time 5 . No leakage of the anastomosis was observed during follow-up of the 6 specimens.…”

Section: Discussionmentioning

confidence: 61%

“…These procedures using dedicated endoscopic techniques and devices were feasible but result in a huge time-consuming procedure and associated high complication rates. We recently decided to improve our technique of gastrojejunal anastomosis using the concept of the tissue-apposing stent 5 . This stent (Cold Axios, Boston Scientific, USA) is self-expandable and fully covered and designed with 2 collars at the ends, which allow good apposition tissue together and thus a new approach to endoluminal anastomosis 6 .…”

Section: Discussionmentioning

confidence: 99%

“…Our team demonstrated previously that it was possible to perform safe and effective endoscopic gastrojejunal anastomosis using luminal apposition stent (LAS) 5 . Thus, we used this self-expandable fully-covered stent (Cold Axios, Boston Scientific, USA) specifically designed with both flanges diameter twice that of the “waist” section, in order to propose a new type of endoluminal anastomosis 6 .…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic esophagogastric anastomosis with luminal apposition Axios stent (LAS) approach: a new concept for hybrid “Lewis Santy”

et al. 2017

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Background and study aims Esophagogastric anastomosis (EGA) has a high risk of leakage. Based upon our experience in endoscopic gastrojejunal anastomosis using LAS, the aim of this study was to verify the technical feasibility and the safety of performing an EGA using a hybrid approach (endoscopic and surgical). Materials and methods A pilot prospective study was performed on 8 survival pigs. The procedure was carried out in 2 stages: (i) surgical step consisting of an esogastrectomy by laparotomy with separated suture of the esophagus and stomach; (ii) endoscopic esophagogastric anastomosis using the LAS. The first 2 pigs allowed for the setting of the 2 steps procedure, and 6 were included in the study for assessing the efficacy and safety of the procedure with a 3-week survival course. The primary endpoint was morbidity and mortality. Results All procedures were successfull. The mean operative time was 98 minutes, with a mean endoscopic time of 46 minutes. Three early deaths occurred within the first weeks, unrelated to the LAS anastomosis. At 3 weeks, endoscopic assessment followed by necropsy demonstrated the right position and the endoscopic removability of the stent with good patency of the esophagogastric anastomosis, without leakage of the endoscopic suture. Pathological examination confirmed the patency of the anastomosis with fusion of mucosal and muscle layers. Conclusion Endoscopic esophagogastric anastomosis with LAS is feasible and reproducible, without anastomotic leakage. It could be a new alternative to perform safe anastomoses, as part of a hybrid approach (surgical and endoscopic).

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Feasibility of Conversion of a New Bariatric Fully Endoscopic Bypass Procedure to Bariatric Surgery: a Porcine Pilot Study

et al. 2022

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Gastrojejunal anastomosis using a tissue-apposing stent: a safety and feasibility study in live pigs

Abstract: 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.

Cited by 18 publications

References 20 publications

Endoscopic ultrasound-guided gastrojejunostomy with a lumen-apposing metal stent: a multicenter, international experience

Endoscopic ultrasound-guided gastrojejunostomy with a lumen-apposing metal stent: a multicenter, international experience

Endoscopic esophagogastric anastomosis with luminal apposition Axios stent (LAS) approach: a new concept for hybrid “Lewis Santy”

Feasibility of Conversion of a New Bariatric Fully Endoscopic Bypass Procedure to Bariatric Surgery: a Porcine Pilot Study

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