New minimal invasive approaches to produce gastro-jejunostomy by flexible endoscope

Introduction: Many unresectable primary or metastatic malignancies and sometimes benign diseases can cause gastric outlet obstruction. Open surgery for palliation is associated with high morbidity and mortality. Although the laparoscopic approach is less traumatic technically difficult and associates with numerous complications. Insertion of duodenal flexible stents is less invasive, but stent occlusion, malignant overgrowth and migration are common. In the last years two new minimal invasive procedures was published. One of them was creation of gastro-jejunostomy with flexible endoscopy in a transgastric way, while the other used magnets to make anastomosis.

Method: A model was developed which combined synthetic materials with biogenic specimens taken from slaughtered domestic pigs. This presented real tissue substance for training without sacrificing animals. At the transgastric procedure an incision was performed on the wall of the stomach with a needle-knife and the endoscope was advanced through into the peritoneal cavity. The first jejunum loop was caught by forceps, and was retracted into the stomach. Another incision was made on jejunum and the edges of the stomach and the jejunum was fixed together with endoclips. At the other experiment two magnets were introduced perorally with endoscopic and fluoroscopic guidance. The first magnet was inserted to the Treitz ligament on a guidewire. The second was placed into the stomach, and the magnets were mated across the walls of the bowels.

Result: The biosynthetic model was suitable to make lifelike endoscopy. Gastro-jejunostomy was developed successfully by transgastric and by magnets as well with standard upper endoscopes and instruments. But both procedures have disadvantages which could be eliminated by the mixing of the two procedures.