TY - JOUR
T1 - Smart self-assembling magnets for endoscopy (SAMSEN) for transoral endoscopic creation of immediate gastrojejunostomy (with video)
AU - Ryou, Marvin
AU - Cantillon-Murphy, Padraig
AU - Azagury, Dan
AU - Shaikh, Sohail N.
AU - Ha, Gabriel
AU - Greenwalt, Ian
AU - Ryan, Michele B.
AU - Lang, Jeffrey H.
AU - Thompson, Christopher C.
PY - 2011/2
Y1 - 2011/2
N2 - Background: Gastrojejunostomy is important for palliation of malignant gastric outlet obstruction and surgical obesity procedures. A less-invasive endoscopic technique for gastrojejunostomy creation is conceptually attractive. Our group has developed a compression anastomosis technology based on endoscopically delivered self-assembling magnets for endoscopy (SAMSEN) to create an instant, large-caliber gastrojejunostomy. Objective: To develop and evaluate an endoscopic means of gastrojejunostomy creation by using SAMSEN. Setting: Developmental laboratory and animal facility. Design: Animal study and human cadaveric study. Subjects Yorkshire pigs (7 cadaver, 5 acute); human (1 cadaver). Interventions: A transoral procedure for SAMSEN delivery was developed in porcine and human cadaver models. Subsequently, gastrojejunostomy creation by using SAMSEN was performed in 5 acute pigs. The endoscope was advanced into the peritoneal cavity through the gastrotomy, and a segment of the small bowel was grasped and pulled closer to the stomach. An enterotomy was created, and a custom overtube was advanced into the small bowel for deployment of the first magnetic assembly. Next, a reciprocal magnetic assembly was deployed in the stomach. The 2 magnetic systems were mated under fluoroscopic and endoscopic guidance. Contrast studies assessed for gastrojejunostomy leak. Immediate necropsies were performed. Main Outcome Measurements: Technical feasibility and complications. Results: Gastrojejunostomy creation by using SAMSEN was successful in all 5 animals. Deep enteroscopy was performed through the stoma without difficulty. No leaks were identified on contrast evaluation. At necropsy, the magnets were properly deployed and robustly coupled together, resistant to vigorous tissue manipulation. Limitations: Acute animal study. Conclusions: Endoscopic creation of immediate gastrojejunostomy by using SAMSEN is technically feasible.
AB - Background: Gastrojejunostomy is important for palliation of malignant gastric outlet obstruction and surgical obesity procedures. A less-invasive endoscopic technique for gastrojejunostomy creation is conceptually attractive. Our group has developed a compression anastomosis technology based on endoscopically delivered self-assembling magnets for endoscopy (SAMSEN) to create an instant, large-caliber gastrojejunostomy. Objective: To develop and evaluate an endoscopic means of gastrojejunostomy creation by using SAMSEN. Setting: Developmental laboratory and animal facility. Design: Animal study and human cadaveric study. Subjects Yorkshire pigs (7 cadaver, 5 acute); human (1 cadaver). Interventions: A transoral procedure for SAMSEN delivery was developed in porcine and human cadaver models. Subsequently, gastrojejunostomy creation by using SAMSEN was performed in 5 acute pigs. The endoscope was advanced into the peritoneal cavity through the gastrotomy, and a segment of the small bowel was grasped and pulled closer to the stomach. An enterotomy was created, and a custom overtube was advanced into the small bowel for deployment of the first magnetic assembly. Next, a reciprocal magnetic assembly was deployed in the stomach. The 2 magnetic systems were mated under fluoroscopic and endoscopic guidance. Contrast studies assessed for gastrojejunostomy leak. Immediate necropsies were performed. Main Outcome Measurements: Technical feasibility and complications. Results: Gastrojejunostomy creation by using SAMSEN was successful in all 5 animals. Deep enteroscopy was performed through the stoma without difficulty. No leaks were identified on contrast evaluation. At necropsy, the magnets were properly deployed and robustly coupled together, resistant to vigorous tissue manipulation. Limitations: Acute animal study. Conclusions: Endoscopic creation of immediate gastrojejunostomy by using SAMSEN is technically feasible.
UR - https://www.scopus.com/pages/publications/79551663691
U2 - 10.1016/j.gie.2010.10.024
DO - 10.1016/j.gie.2010.10.024
M3 - Article
C2 - 21183179
AN - SCOPUS:79551663691
SN - 0016-5107
VL - 73
SP - 353
EP - 359
JO - Gastrointestinal Endoscopy
JF - Gastrointestinal Endoscopy
IS - 2
ER -
