is important for palliation of malignant gastric outlet obstruction and
surgical obesity procedures. A less-invasive endoscopic technique for
gastrojejunostomy creation is conceptually attractive. Our group has
developed a compression anastomosis technology based on endoscopically
delivered self-assembling magnets for endoscopy (SAMSEN) to create an
instant, large-caliber gastrojejunostomy.
OBJECTIVE: To develop and evaluate an endoscopic means of gastrojejunostomy creation by using SAMSEN.
SETTING: Developmental laboratory and animal facility.
DESIGN: Animal study and human cadaveric study.
SUBJECTS: Yorkshire pigs (7 cadaver, 5 acute); human (1 cadaver).
transoral procedure for SAMSEN delivery was developed in porcine and
human cadaver models. Subsequently, gastrojejunostomy creation by using
SAMSEN was performed in 5 acute pigs. The endoscope was advanced into
the peritoneal cavity through the gastrotomy, and a segment of the small
bowel was grasped and pulled closer to the stomach. An enterotomy was
created, and a custom overtube was advanced into the small bowel for
deployment of the first magnetic assembly. Next, a reciprocal magnetic
assembly was deployed in the stomach. The 2 magnetic systems were mated
under fluoroscopic and endoscopic guidance. Contrast studies assessed
for gastrojejunostomy leak. Immediate necropsies were performed.
MAIN OUTCOME MEASUREMENTS: Technical feasibility and complications.
creation by using SAMSEN was successful in all 5 animals. Deep
enteroscopy was performed through the stoma without difficulty. No leaks
were identified on contrast evaluation. At necropsy, the magnets were
properly deployed and robustly coupled together, resistant to vigorous
LIMITATIONS: Acute animal study.
CONCLUSIONS: Endoscopic creation of immediate gastrojejunostomy by using SAMSEN is technically feasible.