The endoscopic transilluminator: an endoscopic device for identification of the proximal jejunum for transgastric endoscopic gastrojejunostomy - 17/08/11

Doi : 10.1016/j.gie.2005.11.045

Sergey V. Kantsevoy, MD, PhD ^⁎, Hideaki Niiyama, MD, Sanjay B. Jagannath, MD, Sydney S.C. Chung, MD, Peter B. Cotton, MD, Christopher J. Gostout, MD, Robert H. Hawes, MD, Pankaj J. Pasricha, MD, Carolyn A. Magee, MS, Cheryl A. Vaughn, RN, BSN, David Barlow, PhD, Hironobu Kawano, BS, Hideki Shimonaka, BS, Anthony N. Kalloo, MD
Current affiliation: Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA

Reprint requests: Sergey V. Kantsevoy, MD, Johns Hopkins University, Division of Gastroenterology, 1830 E. Monument Street, Room 423, Baltimore, MD 21205.

Baltimore, Maryland, USA

Abstract

Background

Localization of the proximal jejunum is important for creation of gastrojejunal anastomosis to palliate gastric outlet obstruction or for treatment of obesity with gastric bypass.

Objective

To facilitate identification of the proximal jejunum during transgastric endoscopic gastrojejunostomy with the use of an endoscopic transilluminator (ET).

Design and Setting

Acute experiments in a live porcine model.

Interventions

The ET is a 3500-mm long, 6F radio-opaque tube with a fiberoptic core that lights up at its distal end. When situated in the intestinal lumen, it transilluminates the bowel wall. With the animal under general anesthesia with endotracheal intubation, a colonoscope was advanced to the proximal jejunum. A plastic tube (3500-mm long, 3.5 mm in diameter) was passed through the biopsy channel and placed into the small bowel. The colonoscope was withdrawn, leaving the tube in place. The ET was introduced into the jejunum through the tube. A gastric wall incision was made and the endoscope was advanced to the peritoneal cavity. The transilluminated loop of the proximal jejunum was identified and gastrojejunal anastomosis was made by use of a previously reported endoscopic technique.

Main Outcome Measurements

Identification of the proximal jejunum.

Results

Eleven pigs (average weight 55 kg) had ET placement. In all of the pigs, placement of the ET was performed easily to the proximal small bowel, and the proximal jejunum was successfully localized by either direct visualization of the transilluminated loop only or with the aid of fluoroscopy. The tip of the ET was usually located about 50 to 70 cm distal to the ligament of Treitz. There were no complications related to the use of ET.

Limitations

The device has not yet been evaluated in humans.

Conclusions

The ET is a safe instrument and can be used to identify the proximal jejunum to facilitate endoscopic gastrojejunostomy.

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Plan

Methods

Results

Discussion

This work was presented, in part, at Digestive Diseases Week, May 16-22, 2003, Orlando, Florida. Kantsevoy S, Niiyama H, Jagannath S, et al. The endoscopic transilluminator (ET): an endoscopic device for identification of proximal jejunum for transgastric endoscopic gastrojejunostomy. Gastrointest Endosc 2003;57(Suppl 1):AB180.
None of the authors have any conflict of interest to report.