Feasibility study of EUS-NOTES as a novel approach for peroral cholecysto-gastrostomy

EUS-guided cholecysto-gastrostomy might be a useful minimally invasive procedure used for salvage drainage in advanced pancreaticobiliary cancers, but also for drainage of the gallbladder in acute cholecystitis in patients deemed unfit for laparoscopic surgery.

Direct EUS-guided cholecysto-gastrostomy with placement of a double flanged expandable metal stents.

This was an animal pilot/feasibility study.

The feasibility of EUS-guided cholecysto-gastrostomy through a transgastric approach was tested in five pigs. Specially designed EUS-guided devices for initial access in the gallbladder and a double flanged expandable metal stent were used in this study.

The results showed the feasibility of EUS-guided cholecysto-gastrostomy based on prototype devices for access in the gallbladder and transgastric stent placement.

Survival feasibility study with prototype devices in a small number of animals.

EUS guided cholecysto-gastrostomy in a porcine model is feasible but technically demanding due to anatomical limitations of the pig and/or complexity of the procedure and the preliminary stage of development of the accessory devices.

NOTES - Natural Orifice Translumenal Endoscopic Surgery; EUS - Endoscopic Ultrasound; EUSFNA - Endoscopic Ultrasound Fine Needle Aspiration.