Transgastric surgery in the abdomen: the dawn of a new era?

摘要

To launch new developments means to break down borders and to disobey rules in an intelligent fashion. Going beyond the "natural" margins among medical disciplines may enrich all sides and may lead to new views of classical indications and therapeutic strategies. In their current papers on endoscopic gastrojejunostomy Kantsevoy, Kalloo,and coworkers of the Apollo Group show, for the first time, more details of their work going beyond the gastric wall and working with an perorally introduced flexible endoscope via a sterile overtube in the abdominal cavity.In an animal study, with survival over 2 weeks, the investigators demonstrated that a patent gastroenteric anastomosis could be created by actively perforating the anterior stomach wall toward the larger curvature with a needle-knife. The cut then was enlarged with a sphincter-otometo 2 cm, which opened the door to the abdominal cavity for highly disinfected and sterilized endoscopes and instruments via a sterile overtube. With a special endoscopic suturing device, the "Eagle Claw" (prototype; Olympus Optical, Tokyo, Japan), a loop of small intestine was fixed to the gastric wall after having been pulled into the gastric cavity. Anastomoses were radiologically patent after 1 week and after 2 weeks on examination after euthanizing the animals.