Tang Shou-Jiang, Olukoga Christopher O, Provost David A, Hogg Deborah, Livingston Edward, Scott Daniel J
Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9151, USA.
Gastrointest Endosc. 2008 Jul;68(1):132-8. doi: 10.1016/j.gie.2008.02.022.
Roux-en-Y gastric bypass is the most commonly performed bariatric operation in the United States. Gastrojejunal (GJ) stomal dilatation associated with weight regain is a late complication. Surgical revision is usually required for stomal or pouch reduction.
Our purpose was to evaluate the technical feasibility, efficacy, and safety of stomal reduction with endoscopic T-tag devices.
Prospective nonsurvival studies were conducted in pigs (n = 2, 110 pounds each).
Three GJ stomas were created in each pig through a midline laparotomy by using circular staplers. Endoscopic GJ stomal reduction/revision was performed on these newly created stomas with an Olympus T-tag device. Necropsy was performed to examine the deployed T-tag locations and procedure-related adjacent tissue/organ injury and to assess the effectiveness of stomal reduction.
Endoscopic stomal revision was performed on 5 stomas with moderate stomal reduction. One GJ stoma could not be accessed easily by endoscopy because of the small size of the gastric pouch. An average of 4 T-tag devices was deployed around each stoma. The procedural time was about 61 +/- 12 minutes for each stomal reduction. Overall, 26 of 39 (66.7%) T-bars were deployed in accepted locations. The stomas were reduced from 1.60 +/- 0.21 mm x 1.44 +/- 0.14 mm to 1.28 +/- 0.29 mm x 0.98 +/- 0.17 mm and the percentage of stomal reduction was 27.3% +/- 13.3%. In the end, a therapeutic gastroscope could not be advanced through the reduced stomas. In 2 stomas, 5 of 39 (12.8%) T-bars injured or attached to the adjacent organs: isolated stomach and abdominal wall.
Nonsurvival pig studies.
Endoscopic stomal reduction with T-tag device is technically feasible and effective in two thirds of trials. However, it is associated with a small risk of adjacent organ/tissue injury with the current prototype device and deployment method.
Roux-en-Y胃旁路术是美国最常施行的减肥手术。与体重反弹相关的胃空肠（GJ）吻合口扩张是一种晚期并发症。通常需要手术修正来缩小吻合口或胃囊。
我们的目的是评估使用内镜T形标签装置缩小吻合口的技术可行性、有效性和安全性。
对猪（n = 2，每头110磅）进行前瞻性非生存研究。
通过中线剖腹术，使用圆形吻合器在每头猪身上创建3个GJ吻合口。使用奥林巴斯T形标签装置对这些新创建的吻合口进行内镜下GJ吻合口缩小/修正。进行尸检以检查已部署的T形标签位置以及与手术相关的邻近组织/器官损伤，并评估吻合口缩小的有效性。
对5个吻合口进行了内镜下吻合口修正，吻合口适度缩小。由于胃囊较小，1个GJ吻合口难以通过内镜轻松到达。每个吻合口周围平均部署了4个T形标签装置。每次吻合口缩小的手术时间约为61±12分钟。总体而言，39个T形条中有26个（66.7%）部署在可接受的位置。吻合口从1.60±0.21毫米×1.44±0.14毫米缩小至1.28±0.29毫米×0.98±0.17毫米，吻合口缩小百分比为27.3%±13.3%。最后，治疗性胃镜无法通过缩小后的吻合口推进。在2个吻合口中，39个T形条中有5个（12.8%）损伤或附着于邻近器官：孤立的胃和腹壁。
非生存猪研究。
使用T形标签装置进行内镜下吻合口缩小在三分之二的试验中技术上可行且有效。然而，使用当前的原型装置和部署方法会有较小的邻近器官/组织损伤风险。
