Feasibility study of EUS-NOTES as a novel approach for peroral cholecysto-gastrostomy.

Abstract

BACKGROUND: EUS-guided cholecysto-gastrostomy might be a useful minimally invasive procedure used for salvage drainage in advanced pancreaticobiliary cancers, but also for drainage of the gallbladder in acute cholecystitis in patients deemed unfit for laparoscopic surgery. OBJECTIVE: Direct EUS-guided cholecysto-gastrostomy with placement of a double flanged expandable metal stents. DESIGN/SETTING: This was an animal pilot/feasibility study. INTERVENTIONS: The feasibility of EUS-guided cholecysto-gastrostomy through a transgastric approach was tested in five pigs. Specially designed EUS-guided devices for initial access in the gallbladder and a double flanged expandable metal stent were used in this study. RESULT: The results showed the feasibility of EUS-guided cholecysto-gastrostomy based on prototype devices for access in the gallbladder and transgastric stent placement. LIMITATIONS: Survival feasibility study with prototype devices in a small number of animals. CONCLUSIONS: EUS guided cholecysto-gastrostomy in a porcine model is feasible but technically demanding due to anatomical limitations of the pig and/or complexity of the procedure and the preliminary stage of development of the accessory devices. ABBREVIATIONS: NOTES - Natural Orifice Translumenal Endoscopic Surgery; EUS - Endoscopic Ultrasound; EUSFNA - Endoscopic Ultrasound Fine Needle Aspiration.