Smart Self-Assembling MagnetS for ENdoscopy (SAMSEN) for transoral endoscopic creation of immediate gastrojejunostomy (with video) - 11/08/11
Reprint requests: Christopher C. Thompson, MD, MSc, Division of Gastroenterology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115Résumé |
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.
Le texte complet de cet article est disponible en PDF.Abbreviations : NOTES, SAMSEN
Plan
| DISCLOSURE: The following authors disclosed financial relationships relevant to this publication: Dr. Ryou: consultant to and royalties from Boston Endoscopic Engineering; consultant to Covidien consultant; Dr. Cantillon-Murphy: consultant to and royalties from Boston Endoscopic Engineering Consultant; and Dr. Thompson: research support from and consultant to Olympus; consultant to Boston Scientific; consultant to and stock in Boston Endoscopic Engineering; consultant to and research support from Bard. The other authors disclosed no financial relationships relevant to this publication. This work was partially supported by a grant awarded to Drs Christopher C. Thompson and Marvin Ryou from the Center for the Integration of Medicine and Innovative Technology. This project was also supported in part by Award Number T32DK007533 from the National Institute Of Diabetes And Digestive And Kidney Diseases awarded to Brigham and Women's Hospital and Marvin Ryou, MD. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute Of Diabetes And Digestive And Kidney Diseases or the National Institutes of Health. |
Vol 73 - N° 2
P. 353-359 - février 2011 Retour au numéro
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