Ultrasound Assisted Endoscopic Gastric Bypass (USA-EGB): a potential endoscopic alternative to surgical bypass, a pre-clinical proof of concept study

Abstract

Background and Aims: endoscopic weight loss procedures have gained traction as minimally invasive options for the primary treatment of obesity. Thus far, we have developed endoscopic procedures that reliably address gastric restriction but result in significantly less weight loss than surgical gastrointestinal bypass. The goal of this non-survival study was to assess the technical feasibility of an endoscopic procedure, that incorporates both gastric restriction and potentially reversible gastrointestinal bypass. Methods: USA-EGB was performed in three consecutive live swine, followed by euthanasia and necropsy. Procedure steps were 1) balloon assisted enteroscopy (BAE) that determines the length of the bypassed limb, 2) EUS-guided gastroenterostomy (EUS-GE) that creates a gastrointestinal anastomosis using a lumen apposing metal stent (LAMS), 3) endoscopic pyloric exclusion (EPS) that disrupts transpyloric continuity resulting in complete gastro-intestinal bypass and 4) gastric restriction (GR) that reduces gastric volume. Results: complete gastrointestinal bypass and gastric restriction was achieved in all three swine. The mean total procedure time was 131 min (113-143 min), mean length of the bypassed limb was 92.5 cm and 180 cm, using short and long overtubes respectively. There were no significant complications. Conclusions: we successfully described USA-EGB in three consecutive live swine. Further studies are needed to access the procedures safety, efficacy, and clinical use.