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First fully endoscopic metabolic procedure with NOTES gastrojejunostomy, controlled bypass length and duodenal exclusion: a 9-month porcine study. Sci Rep 2022; 12:21. [PMID: 34996894 PMCID: PMC8741923 DOI: 10.1038/s41598-021-02921-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 11/18/2021] [Indexed: 01/14/2023] Open
Abstract
We conducted a pilot study of a potential endoscopic alternative to bariatric surgery. We developed a Natural Orifice Transluminal Endoscopic Surgery (NOTES) gastric bypass with controlled bypass limb length using four new devices including a dedicated lumen-apposing metal stent (GJ-LAMS) and pyloric duodenal exclusion device (DED). We evaluated procedural technical success, weight change from baseline, and adverse events in growing Landrace/Large-White pigs through 38 weeks after GJ-LAMS placement. Six pigs (age 2.5 months, mean baseline weight 26.1 ± 2.7 kg) had initial GJ-LAMS placement with controlled bypass limb length, followed by DED placement at 2 weeks. Technical success was 100%. GJ-LAMS migrated in 3 of 6, and DED migrated in 3 of 5 surviving pigs after mucosal abrasion. One pig died by Day 94. At 38 weeks, necropsy showed 100–240 cm limb length except for one at 760 cm. Weight gain was significantly lower in the pigs that underwent endoscopic bypass procedures compared to expected weight for age. This first survival study of a fully endoscopic controlled bypass length gastrojejunostomy with duodenal exclusion in a growing porcine model showed high technical success but significant adverse events. Future studies will include procedural and device optimizations and comparison to a control group.
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Gonzalez JM, Beyer L, Garnier E, Berdah S, Barthet M. Safety and clinical outcomes of endoscopic gastrojejunal anastomosis in obese Yucatan pigs with or without duodenal exclusion using new 20mm lumen-apposing metal stent: A pilot study. Clin Res Hepatol Gastroenterol 2020; 44:786-789. [PMID: 32473815 DOI: 10.1016/j.clinre.2020.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 04/10/2020] [Accepted: 04/13/2020] [Indexed: 02/04/2023]
Affiliation(s)
| | - Laura Beyer
- CERC, Aix-Marseille University, Marseille, France
| | | | | | - Marc Barthet
- CERC, Aix-Marseille University, Marseille, France
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Ratone JP, Caillol F, Zemmour C, Bories E, Pesenti C, Lestelle V, Godat S, Hoibian S, Proux A, Capodano G, Giovannini M. Outcomes of duodenal stenting: Experience in a French tertiary center with 220 cases. Dig Liver Dis 2020; 52:51-56. [PMID: 31401023 DOI: 10.1016/j.dld.2019.06.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 05/19/2019] [Accepted: 06/30/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Endoscopic stenting for malignant gastroduodenal outlet obstruction (MGOO) is described as ineffective and not long-lasting despite a few favorable studies. This study aimed to evaluate the clinical outcomes of a large series of patients in a tertiary center. METHODS A single-center retrospective study was performed using data collected from all patients who received palliative duodenal self-expandable metal stents between January 2011 and December 2016. The primary endpoints were patient diet after the first duodenal procedure (Gastric Outlet Obstruction Scoring System, GOOSS) and clinical success. The secondary endpoints were the median patency duration (calculated according to the Kaplan-Meier method) and the cumulative incidence of reintervention. RESULTS Two-hundred twenty patients were included. The increase in the GOOSS score was significant (p < 0.001), and the clinical success rate was 86.3%. The median estimated patency duration was 9.0 months [6.5-29.1]. Patients with pancreatic adenocarcinoma had significantly longer patency durations (p = 0.02). The estimated cumulative probability of a second duodenal procedure after 4 months was 13%. CONCLUSIONS In this large series of patients who underwent duodenal stenting for MGOO, we observed significant changes in GOOSS scores, a relatively long patency duration compared to findings in previous series, and a low probability of subsequent duodenal procedures, primarily due to a low median overall survival time (4 months).
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Affiliation(s)
| | - Fabrice Caillol
- Paoli-Calmettes Institute, Endoscopy Unit, Marseille, France.
| | - Christophe Zemmour
- Inst Paoli Calmettes, Dept Clin Res & Invest, Biostat & Methodolo Unit, Marseille, France; Aix Marseille Univ, INSERM, IRD, SESSTIM, Marseille, France.
| | - Erwan Bories
- Paoli-Calmettes Institute, Endoscopy Unit, Marseille, France.
| | | | | | - Sébastien Godat
- Paoli-Calmettes Institute, Endoscopy Unit, Marseille, France.
| | - Solène Hoibian
- Paoli-Calmettes Institute, Endoscopy Unit, Marseille, France.
| | - Aurélien Proux
- Paoli-Calmettes Institute, Palliative Unit, Marseille, France.
| | | | - Marc Giovannini
- Paoli-Calmettes Institute, Endoscopy Unit, Marseille, France.
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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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Barthet M, Binmoeller KF, Vanbiervliet G, Gonzalez JM, Baron TH, Berdah S. Natural orifice transluminal endoscopic surgery gastroenterostomy with a biflanged lumen-apposing stent: first clinical experience (with videos). Gastrointest Endosc 2015; 81:215-8. [PMID: 25527056 DOI: 10.1016/j.gie.2014.09.039] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 09/10/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND We established feasibility and safety for natural orifice transluminal endoscopic surgery (NOTES) GI anastomosis with a lumen-apposing stent in live pigs. This approach was performed in 3 patients. OBJECTIVE Creation of a NOTES gastroduodenal anastomosis in patients. DESIGN Case series. SETTING Two tertiary-care referral centers at large academic hospitals in France and in the United States. PATIENTS Patients with refractory benign duodenal stenosis and malignant duodenal obstruction. INTERVENTION NOTES GI anastomosis with a lumen-apposing stent. MAIN OUTCOME MEASUREMENTS Disappearence of gastric outlet obstruction. RESULTS All 3 procedures were technically successful and uneventful, except 1 minor adverse event. There were no instances of stent occlusion or migration during follow-up. All patients resumed a normal diet. LIMITATIONS Small case series. CONCLUSION NOTES gastroenteric anastomosis is feasible and safe in humans. A prospective pilot study is warranted.
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Affiliation(s)
- Marc Barthet
- Faculty of Medicine, Aix-Marseille University, Marseille, France; Gastroenterology, Public Assistance Hospitals of Marseille, Marseille, France
| | - Kenneth F Binmoeller
- Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, California, USA
| | - Geoffroy Vanbiervliet
- Faculty of Medicine, Aix-Marseille University, Marseille, France; Gastroenterology, University Hospital of Nice, Nice, France
| | - Jean-Michel Gonzalez
- Faculty of Medicine, Aix-Marseille University, Marseille, France; Gastroenterology, Public Assistance Hospitals of Marseille, Marseille, France
| | - Todd H Baron
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Stéphane Berdah
- Faculty of Medicine, Aix-Marseille University, Marseille, France; Gastroenterology, Public Assistance Hospitals of Marseille, Marseille, France
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