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.
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.
摘要：
背景：内镜减肥疗法（EBT）已成为肥胖患者的有效治疗方法。不幸的是,大多数程序仅涉及限制胃体积而不改变潜在的代谢。这项研究的目的是研究代谢改变程序的可行性和局限性：“一次吻合胃旁路术（OAGB）”与“自然腔道内镜手术（NOTES）””对人体尸体。
方法：我们在3个人类尸体中使用NOTES方法进行了OAGB。该程序的步骤可分为以下步骤：步骤1，内窥镜套管式胃成形术（ESG）；步骤2，经胃进入腹膜腔；步骤3，确定合适的空肠环；步骤4，将空肠环引入胃中；步骤5，使用管腔贴壁金属支架（LAMS）创建胃空肠造口术；步骤6，胃幽门闭塞过度缝合。
结果：我们在距幽门55、75和105厘米旁路的3具人类尸体中使用NOTES进行了OAGB。尸体的平均体重为64.9kg（61.2-71.7kg）。平均手术时间为157分钟。该程序的最佳旁路长度为105cm。
结论：这项研究在临床前尸体模型中提供了原理证明，NOTES方法可用于执行OAGB，因此,值得在存活的猪模型中进行额外的评估和考虑。
方法：我们在3个人类尸体中使用NOTES方法进行了OAGB。该程序的步骤可分为以下步骤：步骤1，内窥镜套管式胃成形术（ESG）；步骤2，经胃进入腹膜腔；步骤3，确定合适的空肠环；步骤4，将空肠环引入胃中；步骤5，使用管腔贴壁金属支架（LAMS）创建胃空肠造口术；步骤6，胃幽门闭塞过度缝合。
结果：我们在距幽门55、75和105厘米旁路的3具人类尸体中使用NOTES进行了OAGB。尸体的平均体重为64.9kg（61.2-71.7kg）。平均手术时间为157分钟。该程序的最佳旁路长度为105cm。
结论：这项研究在临床前尸体模型中提供了原理证明，NOTES方法可用于执行OAGB，因此,值得在存活的猪模型中进行额外的评估和考虑。
