Hybrid endoluminal stapled pyloroplasty: an alternative treatment option for gastric outlet obstruction syndrome

Cristians Gonzalez, Jung-Myun Kwak, Federico Davrieux, Ryohei Watanabe, Jacques Marescaux, Lee Swanstrom

Research output: Contribution to journalArticle

Abstract

Background: Gastroparesis is a rapidly increasing problem with sometimes devastating consequences. While surgical treatments, particularly laparoscopic pyloroplasty, have recently gained popularity, they require general anesthesia, advanced skills, and can lead to leaks. Peroral pyloromyotomy is a less invasive alternative; however, this technique is technically demanding and not widely available. We describe a hybrid laparo-endoscopic collaborative approach using a novel gastric access device to allow endoluminal stapled pyloroplasty as an alternative treatment option for gastric outlet obstruction. Methods: Under general anesthesia, six pigs (mean weight 33 kg) underwent endoscopic placement of intragastric ports using a technique similar to percutaneous endoscopic gastrostomy. A 5 mm laparoscope was used for visualization. A functional lumen imagine probe was used to measure the cross-sectional area (CSA) and diameter of the pylorus before, after, and at 1 week after intervention. Pyloroplasty was performed using a 5 mm articulating laparoscopic stapler. Gastrotomies were closed by endoscopic clips, endoscopic suture, or combination. After 6–8 days, a second evaluation was performed. At the end of the protocol, all animals were euthanized. Results: Six pyloroplasties were performed. In all cases, this technique was effective in achieving significant pyloric dilatation. The median pre-pyloroplasty pyloric diameter (D) and cross-sectional area (CSA) were 8 mm (4.9–11.6 mm) and 58.6 mm2 (19–107 mm2), respectively. After the procedure, these values increased to 13.41 mm (9.8–17.6 mm) and 147.7 mm2 (76–244 mm2), respectively (p = 0.0152). No important intraoperative events were observed. Postoperatively, all animals did well, with adequate oral intake and no relevant complications. At follow-up endoscopy, all incisions were healed and the pylorus widely patent. Conclusions: Hybrid endoluminal stapled pyloroplasty is a feasible, safe, and effective alternative method for the treatment of gastric outlet obstruction syndrome.

Original languageEnglish
JournalSurgical Endoscopy
DOIs
Publication statusAccepted/In press - 2018 Jan 1

Fingerprint

Gastric Outlet Obstruction
Pylorus
General Anesthesia
Laparoscopes
Gastroparesis
Gastrostomy
Surgical Instruments
Sutures
Endoscopy
Dilatation
Stomach
Swine
Therapeutics
Weights and Measures
Equipment and Supplies

Keywords

  • Endoscopy
  • Gastric emptying
  • Gastroparesis
  • Hybrid surgery
  • Laparo-endoscopic collaborative surgery
  • Pyloroplasty

ASJC Scopus subject areas

  • Surgery

Cite this

Hybrid endoluminal stapled pyloroplasty : an alternative treatment option for gastric outlet obstruction syndrome. / Gonzalez, Cristians; Kwak, Jung-Myun; Davrieux, Federico; Watanabe, Ryohei; Marescaux, Jacques; Swanstrom, Lee.

In: Surgical Endoscopy, 01.01.2018.

Research output: Contribution to journalArticle

Gonzalez, Cristians ; Kwak, Jung-Myun ; Davrieux, Federico ; Watanabe, Ryohei ; Marescaux, Jacques ; Swanstrom, Lee. / Hybrid endoluminal stapled pyloroplasty : an alternative treatment option for gastric outlet obstruction syndrome. In: Surgical Endoscopy. 2018.
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abstract = "Background: Gastroparesis is a rapidly increasing problem with sometimes devastating consequences. While surgical treatments, particularly laparoscopic pyloroplasty, have recently gained popularity, they require general anesthesia, advanced skills, and can lead to leaks. Peroral pyloromyotomy is a less invasive alternative; however, this technique is technically demanding and not widely available. We describe a hybrid laparo-endoscopic collaborative approach using a novel gastric access device to allow endoluminal stapled pyloroplasty as an alternative treatment option for gastric outlet obstruction. Methods: Under general anesthesia, six pigs (mean weight 33 kg) underwent endoscopic placement of intragastric ports using a technique similar to percutaneous endoscopic gastrostomy. A 5 mm laparoscope was used for visualization. A functional lumen imagine probe was used to measure the cross-sectional area (CSA) and diameter of the pylorus before, after, and at 1 week after intervention. Pyloroplasty was performed using a 5 mm articulating laparoscopic stapler. Gastrotomies were closed by endoscopic clips, endoscopic suture, or combination. After 6–8 days, a second evaluation was performed. At the end of the protocol, all animals were euthanized. Results: Six pyloroplasties were performed. In all cases, this technique was effective in achieving significant pyloric dilatation. The median pre-pyloroplasty pyloric diameter (D) and cross-sectional area (CSA) were 8 mm (4.9–11.6 mm) and 58.6 mm2 (19–107 mm2), respectively. After the procedure, these values increased to 13.41 mm (9.8–17.6 mm) and 147.7 mm2 (76–244 mm2), respectively (p = 0.0152). No important intraoperative events were observed. Postoperatively, all animals did well, with adequate oral intake and no relevant complications. At follow-up endoscopy, all incisions were healed and the pylorus widely patent. Conclusions: Hybrid endoluminal stapled pyloroplasty is a feasible, safe, and effective alternative method for the treatment of gastric outlet obstruction syndrome.",
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AU - Marescaux, Jacques

AU - Swanstrom, Lee

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N2 - Background: Gastroparesis is a rapidly increasing problem with sometimes devastating consequences. While surgical treatments, particularly laparoscopic pyloroplasty, have recently gained popularity, they require general anesthesia, advanced skills, and can lead to leaks. Peroral pyloromyotomy is a less invasive alternative; however, this technique is technically demanding and not widely available. We describe a hybrid laparo-endoscopic collaborative approach using a novel gastric access device to allow endoluminal stapled pyloroplasty as an alternative treatment option for gastric outlet obstruction. Methods: Under general anesthesia, six pigs (mean weight 33 kg) underwent endoscopic placement of intragastric ports using a technique similar to percutaneous endoscopic gastrostomy. A 5 mm laparoscope was used for visualization. A functional lumen imagine probe was used to measure the cross-sectional area (CSA) and diameter of the pylorus before, after, and at 1 week after intervention. Pyloroplasty was performed using a 5 mm articulating laparoscopic stapler. Gastrotomies were closed by endoscopic clips, endoscopic suture, or combination. After 6–8 days, a second evaluation was performed. At the end of the protocol, all animals were euthanized. Results: Six pyloroplasties were performed. In all cases, this technique was effective in achieving significant pyloric dilatation. The median pre-pyloroplasty pyloric diameter (D) and cross-sectional area (CSA) were 8 mm (4.9–11.6 mm) and 58.6 mm2 (19–107 mm2), respectively. After the procedure, these values increased to 13.41 mm (9.8–17.6 mm) and 147.7 mm2 (76–244 mm2), respectively (p = 0.0152). No important intraoperative events were observed. Postoperatively, all animals did well, with adequate oral intake and no relevant complications. At follow-up endoscopy, all incisions were healed and the pylorus widely patent. Conclusions: Hybrid endoluminal stapled pyloroplasty is a feasible, safe, and effective alternative method for the treatment of gastric outlet obstruction syndrome.

AB - Background: Gastroparesis is a rapidly increasing problem with sometimes devastating consequences. While surgical treatments, particularly laparoscopic pyloroplasty, have recently gained popularity, they require general anesthesia, advanced skills, and can lead to leaks. Peroral pyloromyotomy is a less invasive alternative; however, this technique is technically demanding and not widely available. We describe a hybrid laparo-endoscopic collaborative approach using a novel gastric access device to allow endoluminal stapled pyloroplasty as an alternative treatment option for gastric outlet obstruction. Methods: Under general anesthesia, six pigs (mean weight 33 kg) underwent endoscopic placement of intragastric ports using a technique similar to percutaneous endoscopic gastrostomy. A 5 mm laparoscope was used for visualization. A functional lumen imagine probe was used to measure the cross-sectional area (CSA) and diameter of the pylorus before, after, and at 1 week after intervention. Pyloroplasty was performed using a 5 mm articulating laparoscopic stapler. Gastrotomies were closed by endoscopic clips, endoscopic suture, or combination. After 6–8 days, a second evaluation was performed. At the end of the protocol, all animals were euthanized. Results: Six pyloroplasties were performed. In all cases, this technique was effective in achieving significant pyloric dilatation. The median pre-pyloroplasty pyloric diameter (D) and cross-sectional area (CSA) were 8 mm (4.9–11.6 mm) and 58.6 mm2 (19–107 mm2), respectively. After the procedure, these values increased to 13.41 mm (9.8–17.6 mm) and 147.7 mm2 (76–244 mm2), respectively (p = 0.0152). No important intraoperative events were observed. Postoperatively, all animals did well, with adequate oral intake and no relevant complications. At follow-up endoscopy, all incisions were healed and the pylorus widely patent. Conclusions: Hybrid endoluminal stapled pyloroplasty is a feasible, safe, and effective alternative method for the treatment of gastric outlet obstruction syndrome.

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