Stents in Gastrointestinal Diseases

Stent is a medical device originally designed for recanalization and/or sealing of any obstructing or leaking lesion. In gastroenterology, it has a major role in recanalization of gastrointestinal (GI) tumors and postoperative leak sealing. Among several materials and models used in stent manufacturing, self-expandable metallic stents (SEMS) are the most common used stents. Over the years, SEMS has evolved into a standard of care medical device in several oncological conditions, such as advanced esophageal cancer. Other potential applications are drug-eluting devices, scar tissue modeling for benign conditions, and GI tract drainage/anastomosis. The aim of this chapter is to review the most common GI stent models and its indications in gastrointestinal diseases

Gastrojejunal Anastomosis Exclusively Using the 'NOTES' Technique in Live Pigs: A Feasibility and Reliability Study

Introduction. Natural orifice transluminal endoscopic surgery [NOTES] could reduce procedure-associated morbidity and mortality. The aim of this study was to determine the feasibility of performing a simple model of gastrojejunal anastomosis in a living porcine model exclusively using NOTES. Methods. It was a prospective experimental animal study concerning pigs weighing between 25 and 30 kg. Endoscopies were performed using a double-channel gastroscope. A preliminary phase allowed for the development of the technique on 3 animals that were immediately euthanized. The experimental phase included the implementation of a gastrojejunal anastomosis in 9 animals. Antibiotic therapy was continued for 7 days with gradual feeding. Surviving animals were euthanized after 3 weeks. Anastomosis permeability in each animal was confirmed by opacification, endoscopy, and histopathological analysis. The main outcome measurements were the feasibility and animal survival at 3 weeks postsurgery. Results. The entire procedure was performed on 9 animals [4 males and 5 females]. Anastomosis required 4.7 ± 1.2 stitches [range 4-7]. The average total length of the procedure was 143 ± 50.8 minutes [range 87-225 minutes]. One bleeding, 2 suture dehiscences, and a poor stomach incision were the immediate complications endoscopically resolved. At 3 weeks, 5 animals had survived. Three animals died as a result of anastomotic leakage confirmed at necropsy and histopathology. In the surviving animals, histology confirmed permeable anastomoses with collagen scar tissue and continuity of the mucosa and mucosa muscle layers. Conclusion. Successful gastrojejunal anastomosis by NOTES is technically feasible but is subject to a learning curve

Endoscopic full-thickness biopsy of the gastric wall with defect closure by using an endoscopic suturing device: survival porcine study

Background: The pathogenesis of several common gastric motility diseases and functional GI disorders remains essentially unexplained. Gastric wall biopsies that include the muscularis propria to evaluate the enteric nervous system, interstitial cells of Cajal, and immune cells can provide important insights for our understanding of the etiology of these disorders. Objectives: To determine the technical feasibility, reproducibility, and safety of performing a full-thickness gastric biopsy (FTGB) by using a submucosal endoscopy with mucosal flap (SEMF) technique; the technical feasibility, reproducibility, and safety of tissue closure by using an endoscopic suturing device; the ability to identify myenteric ganglia in resected specimens; and the long-term safety. Design: Single center, preclinical survival study. Setting: Animal research laboratory, developmental endoscopy unit. Subjects: Twelve domestic pigs. Interventions: Animals underwent an SEMF procedure with gastric muscularis propria resection. The resultant offset mucosal entry site was closed by using an endoscopic suturing device. Animals were kept alive for 2 weeks. Main Outcome Measurements: The technical feasibility, reproducibility, and safety of the procedure; the clinical course of the animals; the histological and immunochemical evaluation of the resected specimen to determine whether myenteric ganglia were present in the sample. Results: FTGB was performed by using the SEMF technique in all 12 animals. The offset mucosal entry site was successfully closed by using the suturing device in all animals. The mean resected tissue specimen size was 11 mm. Mean total procedure time was 61 minutes with 2 to 4 interrupted sutures placed per animal. Histology showed muscularis propria and serosa, confirming full-thickness resections in all animals. Myenteric ganglia were visualized in 11 of 12 animals. The clinical course was uneventful. Repeat endoscopy and necropsy at 2 weeks showed absence of ulceration at both the mucosal entry sites and overlying the more distal muscularis propria resection sites. There was complete healing of the serosa in all animals with minimal single-band adhesions in 5 of 12 animals. Retained sutures were present in 10 of 12 animals. Limitations: Animal experiment. Conclusions: FTGB by using the SEMF technique and an endoscopic suturing device is technically feasible, reproducible, and safe. Larger tissue specimens will allow improved analysis of multiple cell types