iGIE : innovation, investigation and insights · 2024
Endosonography-guided suture device for gastrointestinal lumen-to-lumen apposition in a porcine model.
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AbiMansour Jad, Kamba Shunsuke, Abu Dayyeh Barham K, Law Ryan J, Chandrasekhara Vinay, Rajan Elizabeth, Storm Andrew C
Аннотация
BACKGROUND AND AIMS: The ability to effectively tether 2 separate lumens would simplify performance of transluminal therapeutic endoscopic ultrasound (EUS). This article describes a novel device permitting simple and effective luminal apposition under EUS guidance.
METHODS: A porcine preclinical study using 1 domestic pig was performed to show proof-of-concept of a novel suturing device that can be deployed with EUS to appose the gallbladder wall to the stomach. The goal is to facilitate a simple and straightforward approach to cholecystogastrostomy using a lumen-apposing metal stent.
RESULTS: EUS was performed to identify the porcine gallbladder. The device was used to puncture across the gastric wall and into the gallbladder. Once needle access was obtained, 4 flexible braided suture tags were extruded over a 3-0 polypropylene suture into the gallbladder lumen. Upon applying suture tension, the tags bunch to form a secure loop within the gallbladder lumen. With tension on this suture, the gallbladder may be brought up to the gastric wall and the transmural 3-0 suture then cinched at the gastric mucosa to effect durable luminal apposition. After this, cholecystogastrostomy with an electrocautery-enhanced lumen-apposing metal stent was performed using a standard freehand technique.
CONCLUSIONS: A novel EUS-guided suturing device permits apposition of the porcine gallbladder and stomach, facilitating EUS-guided transmural gallbladder drainage. This approach may affect the safety and technical success rates of novel translumenal therapeutic EUS procedures.
METHODS: A porcine preclinical study using 1 domestic pig was performed to show proof-of-concept of a novel suturing device that can be deployed with EUS to appose the gallbladder wall to the stomach. The goal is to facilitate a simple and straightforward approach to cholecystogastrostomy using a lumen-apposing metal stent.
RESULTS: EUS was performed to identify the porcine gallbladder. The device was used to puncture across the gastric wall and into the gallbladder. Once needle access was obtained, 4 flexible braided suture tags were extruded over a 3-0 polypropylene suture into the gallbladder lumen. Upon applying suture tension, the tags bunch to form a secure loop within the gallbladder lumen. With tension on this suture, the gallbladder may be brought up to the gastric wall and the transmural 3-0 suture then cinched at the gastric mucosa to effect durable luminal apposition. After this, cholecystogastrostomy with an electrocautery-enhanced lumen-apposing metal stent was performed using a standard freehand technique.
CONCLUSIONS: A novel EUS-guided suturing device permits apposition of the porcine gallbladder and stomach, facilitating EUS-guided transmural gallbladder drainage. This approach may affect the safety and technical success rates of novel translumenal therapeutic EUS procedures.