Creating a durable endoscopic ultrasound-guided gastroenteric anastomosis: A porcine-model pilot study

Abstract

Introduction and aims

The performance of gastroenteric anastomosis (GEA) utilizing endoscopic ultrasound (EUS) and lumen-apposing metal stents (LAMSs) is safe and effective for treating malignant gastric outlet obstruction, but not in benign disease, due to unpredictable GEA closure after LAMS removal. Our aim was to evaluate different endoscopic techniques for creating a durable GEA in porcine models.

Material and methods

An animal study in porcine models was conducted at the vivarium of a tertiary care hospital in Mexico City, between September and November 2023. Five techniques were carried out: direct technique (DT), radial cut (RC) technique, linear cut (LC) technique, absolute ethanol sclerotherapy (AES), and argon plasma coagulation (APC). Technical efficacy, safety, and lasting patency of the anastomosis at 4 weeks after the intervention and LAMS removal were evaluated.

Results

Ten porcine models, 2 per group, were included. Technical success was 100% and clinical success 0%. Procedure times were 29 min for the DT, 88 min for the RC technique, 74 min for the LC technique, 41 min for AES, and 75 min for APC. The RC technique had the largest anastomosis area (742 mm²). There was one adverse event (10%); it was mild and did not require any additional intervention.

Conclusions

Although clinical success was not achieved with any of the techniques, the technical modifications were safe, providing a better understanding of the mechanisms involved in GEA and paving the way for new explorations.