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Fluoroscopy-Guided Gastrojejunostomy Creation with Lumen-Apposing Metal Stent in a Porcine Model

  • Laboratory Investigation
  • Non-Vascular Interventions
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the technical feasibility of fluoroscopy-guided gastrojejunostomy creation in a porcine model.

Methods

Eight domestic female pigs (median, 15.6 kg; range, 14.5–16.3 kg) were included in this study. The proximal jejunum was punctured from the stomach using a Rösch–Uchida Transjugular Liver Access Set through the mouth, and a lumen-apposing metal stent was placed across the puncture tract between the stomach and the proximal jejunum. All animals were euthanized 6 weeks after the procedure.

Results

The fistulous tract creation and stent insertion with confirmed patency were successful in eight animals, rendering a technical success rate of 100%. Gross inspection showed a matured and patent fistulous tract between the stomach and the proximal jejunum in seven animals. In one animal, the colon between the stomach and the proximal jejunum was inadvertently punctured followed by migration of the stent from the stomach into the colon after the procedure to form a delayed jejunocolostomy. A stent migration and an inadvertent traversing the tail of pancreas by the stent were observed in another two animals without signs of bleeding, infection, or pancreatitis. All animals survived until the end of this study without change in their behavior or appetite. Histological analysis showed that all the fistulous tracts had matured with continuity of submucosal, muscular, and serosal layers, and without destruction of epithelial layers.

Conclusions

Fluoroscopy-guided gastrojejunostomy creation is technically feasible in a porcine model but requires refinement of the targeting technique to avoid transgression of nontarget organs.

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Funding

This study was funded by the Fundamental Research Funds for the Central Universities (Grant No. 3332018076 to Xiaowu Zhang); Beijing Hope Run Special Fund of Cancer Foundation of China (Grant No. LC2017B09 to Xiaowu Zhang). The funders of the study had no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.

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Author notes

  1. Jingui Li and Tao Gong have contributed equally to this work and are co-first authors.

Authors and Affiliations

  1. Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China

    Jingui Li, Tao Gong, Jiaywei Tsauo, He Zhao, Xiaowu Zhang, Mingchen Sang & Xiao Li

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  1. Jingui Li
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  2. Tao Gong
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  3. Jiaywei Tsauo
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  4. He Zhao
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  5. Xiaowu Zhang
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  7. Xiao Li
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Corresponding author

Correspondence to Jiaywei Tsauo.

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All procedures performed in studies involving animals were in accordance with the ethical standards of the institution or practice at which the studies were conducted. For this type of study, the Institutional Review Board (IRB) approval is not required.

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Li, J., Gong, T., Tsauo, J. et al. Fluoroscopy-Guided Gastrojejunostomy Creation with Lumen-Apposing Metal Stent in a Porcine Model. Cardiovasc Intervent Radiol 43, 1687–1694 (2020). https://doi.org/10.1007/s00270-020-02589-0

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  • DOI: https://doi.org/10.1007/s00270-020-02589-0

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