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Natural Orifice Transluminal Endoscopic One-Anastomosis Gastric Bypass: a Feasibility Study Using Human Cadavers

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Abstract

Background

Endoscopic bariatric therapies (EBT) has emerged as an effective treatment in the management of the patient with obesity. Unfortunately, most procedures involve only the restriction of gastric volume without altering the underlying metabolism. The objective of this study was to investigate the practicability and limitations of the metabolic altering procedures: “One anastomosis gastric bypass (OAGB)” with “natural orifice transluminal endoscopic surgery (NOTES)” on human cadavers.

Methods

We performed OAGB with NOTES approach in 3 human cadavers. The steps of the procedure can be divided as follows: step 1, endoscopic sleeve gastroplasty (ESG); step 2, trans-gastric access to peritoneal cavity; step 3, identification of suitable loop of jejunum; step 4, introduction of the jejunal loop into the stomach; step 5, creation of the gastro-jejunostomy with lumen-apposing metal stent (LAMS); step 6, gastric pylorus occlusion with overstitch.

Results

We performed OAGB with NOTES in 3 human cadavers with bypassed bilio-pancreatic limb of 55, 75, and 105 cm from the pylorus. The average weight for the cadavers was 64.9 kg (61.2–71.7 kg). The mean procedure time was 157 min. The optimal bypassed length for the procedure was 105 cm.

Conclusions

This study has provided proof-of-principle in a pre-clinical cadaveric model that NOTES approach can be used to perform OAGB and, therefore, merits additional evaluation and consideration in surviving porcine model.

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Authors and Affiliations

  1. Department of Upper Gastrointestinal & Bariatric Surgery, Division of Surgery, Singapore General Hospital, Academia, 20 College Road, Singapore, 169856, Singapore

    Chin Hong Lim, Zhen Jin Lee, Tiffany Lye, Hock Soo Ong & Jeremy Tan

  2. Department of Gastroenterology & Hepatology, Division of Medicine, Singapore General Hospital, Singapore, Singapore

    Asokkumar Ravishankar

  3. Department of Upper Gastrointestinal & Bariatric Surgery, Sengkang General Hospital, Singapore, Singapore

    Baldwin Yeung

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  1. Chin Hong Lim
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  2. Zhen Jin Lee
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  4. Asokkumar Ravishankar
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  5. Baldwin Yeung
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  7. Jeremy Tan
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Correspondence to Chin Hong Lim.

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IRB approval and written consent is not required for cadaver study.

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Key Points

• Many patients perceive bariatric-metabolic surgery as dangerous and believe that living with severe obesity is safer than undergoing surgery.

• Endoscopic bariatric therapies (EBT) using flexible gastrointestinal endoscopy have emerged as a reliable alternative to traditional laparoscopic approach.

• We performed OAGB with NOTES in 3 human cadavers and the optimal bypassed length for the procedure was 105 cm.

• The twinning of a highly effective OAGB in weight loss and metabolic syndrome resolution, combined with “incision-less” surgery, will present a more acceptable option for this disease.

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Lim, C.H., Lee, Z.J., Lye, T. et al. Natural Orifice Transluminal Endoscopic One-Anastomosis Gastric Bypass: a Feasibility Study Using Human Cadavers. OBES SURG 32, 3787–3795 (2022). https://doi.org/10.1007/s11695-022-06273-9

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