Endosonography-guided suture device for gastrointestinal lumen-to-lumen apposition in a porcine model

Abstract

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.