FIST EXCLUSIVE ENDOSCOPIC BYPASS (EEBP) IN PORCINE MODEL, INCLUDING LIMB LENGTH SELECTION AND DUODENAL EXCLUSION: VALIDATION OF FEASIBILITY, REPRODUCIBILITY AND CLINICAL EFFECT (WITH VIDEO)

Aims We developed the first exclusively endoscopic bypass (EEBP). The aim was to validate the feasibility and safety of the procedure, and to evaluate the effect on growth curve.

Methods The experiment was conducted between 2019 and 2021. Four devices were developed to perform EEBP, including a gastrojejunostomy (GJA) with bypassed loop length control (150cm from pylorus) and duodenal exclusion: a modified lumen apposing stent (GJ-LAMS), an atraumatic forceps, a duodenal exclusion device (DED) and a graduated luminous catheter for loop tracking. The procedures were performed in growing Landrace/Large-White pigs with a dual channel endoscope under CO2. The first step was the GJA, followed by DED placement 2 weeks later. The follow-up was 9 months.

Results Six pigs (mean initial weight 26.1±2.7 kg) were included. The EEBP technical success rate was 100% without adverse events. In follow-up, the GJ-LAMS migrated in 3 pigs, without closure of the anastomosis, and were replaced. The DED migrated in 3 pigs. All stents could be removed. At autopsy, anastomoses diameters were 12 to 20mm, the excluded limb length ranged from 100 cm to 240 cm. The anastomoses healed, without evidence of fistula. One animal died 4 days before the end of follow-up, of undetermined cause. The mean weight was 45.6±12.3 kg at 38 weeks (average gain: 19.1±11.3 kg), which was significantly lower than expected growth curves for this breed (100kg).

Conclusions This is the first study demonstrating the technical feasibility and reproducibility of an EEBP showing a break in the weight curve in growing animals.

Publication History

Article published online:
14 April 2022