Gonzalez Jean-Michel, Duconseil Pauline, Ouazzani Sohaib, Berdah Stephane, Cauche Nicolas, Delattre Cecilia, Peetermans Joyce A, Gjata Ornela, Santoro-Schulte Agostina, Barthet Marc
Department of Hepatogastroenterology, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, Marseille, France.
Faculty of Medicine, Aix-Marseille University, Chemin des Bourrely, Cedex 20, 13915, Marseille, France.
Obes Surg. 2022 Jul;32(7):2280-2288. doi: 10.1007/s11695-022-06065-1. Epub 2022 Apr 25.
Bariatric endoscopic procedures are emerging as alternatives to bariatric surgical procedures. This study aimed to assess if a natural orifice transluminal endoscopic surgery (NOTES) bariatric procedure could be converted to a surgical duodenal-jejunal bypass (DJB) or sleeve gastrectomy (SG).
This 12-week prospective study compared 4 test pigs to 3 control (no procedures) pigs aged 3 months at baseline. The test pigs received a fully endoscopic NOTES-based bypass including measurement of the bypassed limb and creation of a gastrojejunal anastomosis (GJA) using gastrojejunal lumen-apposing metal stents (GJ-LAMS) at Week 0, placement of a duodenal exclusion device (DED) at Week 2, and randomization to DJB or SG surgery at Week 8 with subsequent 4-week follow-up. At Week 12, the pigs were sacrificed and necropsy was performed.
Endoscopic procedures were technically successful. One pig did not receive a DED due to early GJ-LAMS migration leading to premature closure of the GJA. At Week 8, all 4 pigs were doing well, and the remaining 3 GJ-LAMS and 3 DEDs were uneventfully endoscopically removed. Two one-anastomosis DJB were performed, and 2 SG were performed, closing in one case the site of the previous GJA. The surgical procedures were technically feasible and uneventful during follow-up. Necropsy assessments showed no local or peritoneal inflammation or abscess and no leakage or fistula.
An endoscopic bariatric bypass can be transitioned to a one-anastomosis duodenal-jejunal bypass or sleeve gastrectomy, without complications.
减重内镜手术正逐渐成为减重外科手术的替代方案。本研究旨在评估经自然腔道内镜手术（NOTES）的减重手术是否可以转换为外科十二指肠空肠旁路术（DJB）或袖状胃切除术（SG）。
这项为期12周的前瞻性研究将4只试验猪与3只基线时3个月大的对照（未进行任何手术）猪进行比较。试验猪在第0周接受了基于NOTES的全内镜旁路手术，包括测量旷置肠袢并使用胃空肠腔对腔金属支架（GJ-LAMS）建立胃空肠吻合术（GJA），在第2周放置十二指肠封闭装置（DED），并在第8周随机接受DJB或SG手术，随后进行4周的随访。在第12周，对猪实施安乐死并进行尸检。
内镜手术在技术上取得成功。1只猪由于早期GJ-LAMS移位导致GJA过早闭合而未接受DED。在第8周时，所有4只猪情况良好，其余（3个）GJ-LAMS和3个DED均通过内镜顺利取出。实施了2例单吻合口DJB，2例SG，其中1例封闭了先前GJA的部位。手术过程在技术上可行，随访期间无异常情况。尸检评估显示无局部或腹膜炎症或脓肿，无渗漏或瘘管形成。
内镜减重旁路手术可以转换为单吻合口十二指肠空肠旁路术或袖状胃切除术，且无并发症。
