Vanbiervliet Geoffroy, Bonin Eduardo Aimore, Garcès Rodrigo, Gonzalez Jean-Michel, Garnier Emmanuelle, Paul Marie Christine Saint, Berdah Stéphane, Barthet Marc
Endoscopie digestive, Hôpital L'Archet 2, Centre Hospitalier Universitaire, Nice, France.
CERC, LBA UMRT24, Université Aix-Marseille, Faculté de médecine, Marseille, France.
Endoscopy. 2014 Oct;46(10):871-7. doi: 10.1055/s-0034-1377347. Epub 2014 Jul 14.
Various techniques using surgical and natural orifice transluminal endoscopic surgery (NOTES) have been evaluated to create a gastrojejunal bypass. The aim of the current study was to determine the safety, feasibility, and efficacy of a new technique using a pure endoscopic approach and tissue-apposing stent placement for gastrojejunal anastomosis (GJA).
This was a prospective, experimental study on six live pigs weighing 20 - 45 kg. Endoscopies were performed using a double-channel gastroscope, and included the creation of a GJA using a tissue-apposing, fully covered, self-expanding metallic stent. Antibiotic therapy was continued for 7 days after the procedure, and food was gradually reintroduced from Day 3. Changes in weight following the procedure were compared with a control group of age-matched animals. Anastomosis functionality was confirmed by endoscopy at 3 weeks (before the animals were euthanized), and during histopathological analysis. The primary outcomes were morbidity and mortality at 3 weeks. Secondary outcomes were technical feasibility, procedure time, and patency of the GJA.
The procedures were performed successfully in all animals. The mean procedure time was 26 ± 6.7 minutes (range 15 - 32 minutes). One case of stent migration occurred during the procedure; the stent was successfully replaced using the same procedure. All animals were alive after 3 weeks. The mean weight gain during follow-up was 0.85 ± 2.56 kg (range - 2 to + 2 kg) compared with 5.2 ± 1.6 kg (range 3 - 7 kg) in control animals (P = 0.007). At necropsy, the stents were still in place in all animals, without evidence of peritonitis. Histopathology confirmed permeable anastomoses with continuity of the mucosa and mucosa muscle layers.
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.
已经对使用外科手术以及经自然腔道内镜手术（NOTES）的各种技术进行了评估，以创建胃空肠吻合术。本研究的目的是确定一种使用纯内镜方法和组织贴合支架置入进行胃空肠吻合术（GJA）的新技术的安全性、可行性和有效性。
这是一项针对6头体重20 - 45千克的活猪的前瞻性实验研究。使用双通道胃镜进行内镜检查，包括使用组织贴合、完全覆盖、自膨胀金属支架创建GJA。术后持续使用抗生素治疗7天，从第3天开始逐渐重新引入食物。将术后体重变化与年龄匹配的对照组动物进行比较。在3周时（动物安乐死之前）以及组织病理学分析期间，通过内镜检查确认吻合口功能。主要结局是3周时的发病率和死亡率。次要结局是技术可行性、手术时间和GJA的通畅性。
所有动物的手术均成功完成。平均手术时间为26 ± 6.7分钟（范围15 - 32分钟）。手术过程中发生1例支架移位；使用相同手术成功更换了支架。3周后所有动物均存活。随访期间平均体重增加0.85 ± 2.56千克（范围 - 2至 + 2千克），而对照动物为5.2 ± 1.6千克（范围3 - 7千克）（P = 0.007）。尸检时，所有动物的支架仍在位，无腹膜炎迹象。组织病理学证实吻合口可渗透，黏膜和黏膜肌层连续。
在猪模型中，使用纯内镜方法和标准内镜设备，采用组织贴合支架进行GJA是安全、可行且可重复的，无吻合口漏。
