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Culetto A, Gonzalez JM, Vanbiervliet G, da Garcia PM, Tellechea JI, Garnier E, Berdah S, Barthet M. Endoscopic esophagogastric anastomosis with luminal apposition Axios stent (LAS) approach: a new concept for hybrid "Lewis Santy". Endosc Int Open 2017; 5:E455-E462. [PMID: 28573178 PMCID: PMC5451277 DOI: 10.1055/s-0043-106577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 02/10/2017] [Indexed: 12/13/2022] Open
Abstract
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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Affiliation(s)
- Adrian Culetto
- Department of Gastroenterology, Public Assistance Hospitals of Marseille, North Hospital, Marseille, France,Aix-Marseille University, CERC, Faculty of Medecin, Marseille, France,Corresponding author Adrian Culetto, MD Department of GastroenterologyPublic Assistance Hospitals of MarseilleNorth Hospital, Marseille, France
| | - Jean-Michel Gonzalez
- Department of Gastroenterology, Public Assistance Hospitals of Marseille, North Hospital, Marseille, France,Aix-Marseille University, CERC, Faculty of Medecin, Marseille, France
| | - Geoffroy Vanbiervliet
- Aix-Marseille University, CERC, Faculty of Medecin, Marseille, France,Department of Endoscopy, University Hospital of Nice, Nice, France
| | - Pablo Mira da Garcia
- Department of Gastroenterology, Public Assistance Hospitals of Marseille, North Hospital, Marseille, France,Aix-Marseille University, CERC, Faculty of Medecin, Marseille, France
| | - Juan Ignacio Tellechea
- Department of Gastroenterology, Public Assistance Hospitals of Marseille, North Hospital, Marseille, France,Aix-Marseille University, CERC, Faculty of Medecin, Marseille, France
| | | | - Stephane Berdah
- Aix-Marseille University, CERC, Faculty of Medecin, Marseille, France,Department of Digestive Surgery, Public Assistance Hospitals of Marseille, Marseille, France
| | - Marc Barthet
- Department of Gastroenterology, Public Assistance Hospitals of Marseille, North Hospital, Marseille, France,Aix-Marseille University, CERC, Faculty of Medecin, Marseille, France
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