Endoscopic transgastric lymphadenectomy by using EUS for selection and guidance

Area of Science:

• Gastroenterology
• Surgical Innovation
• Endoscopic Imaging

Background:

• Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is a standard diagnostic tool for lymphadenopathy.
• However, EUS-FNA may not be sufficient for complete node removal or sampling small malignant foci.
• A new minimally invasive technique is needed for lymph node assessment and removal.

Purpose of the Study:

• To develop and evaluate a novel EUS-guided endoscopic-transgastric method for lymph node marking and lymphadenectomy.
• To assess the feasibility of this transgastric approach for accessing and removing perigastric lymph nodes.

Main Methods:

• An experimental study was conducted using six pigs.
• A transgastric procedure involved EUS-guided puncture of perigastric lymph nodes using a 19-gauge needle.
• A metal anchor with thread was deployed for node marking and traction, followed by endoscopic dissection, lymphadenectomy, and gastric closure with a suturing system.

Main Results:

• Successful lymph node marking with an anchor and thread was achieved in all pigs.
• Nodes could be effectively pulled against the gastric wall for subsequent removal.
• The complete procedure, including node tagging, gastric incision, lymphadenectomy, and closure, was successfully performed in 2 out of 6 examinations.
• No serious complications were observed during the study.

Conclusions:

• The EUS-guided transgastric approach for lymphadenectomy is feasible in an animal model.
• This technique allows for endoscopic selection, marking, and removal of perigastric lymph nodes.
• Further studies are needed to validate this method in human subjects.