Gastric Bypass Via Natural Orifice Trans-Luminal Endoscopic Surgical (NOTES) Approach: A Surviving Porcine Study

Bariatric surgery has transformed metabolic outcomes for individuals with type 2 diabetes mellitus (DM) and obesity. While traditional Roux-en-Y gastric bypass (RYGB) shows significant efficacy, only 1% of eligible North Americans undergo this surgery, largely due to associated morbidity and mortality. Endoscopic bariatric therapies (EBT), offering incisionless options, have emerged but demonstrate limited long-term efficacy. This study introduces the Natural Orifice Transluminal Endoscopic Gastric Bypass (NOTES-GB) as a potential advancement in bariatric treatments.

Nine adolescent male pigs were acclimated and fed a customized obesogenic diet for 3 months to induce obesity. The NOTES-GB procedure was performed under general anesthesia, utilizing an endoscopic approach to create a gastrojejunal anastomosis and pyloric exclusion.

All procedures were technically successful, with a mean operation time of 215.4 min. Complications included one case of stent migration and one sudden death due to ischemic bowel. A staged approach combining single anastomosis sleeve jejunal (SASJ) followed by conversion to one-anastomosis gastric bypass (OAGB) minimized the risk of severe malnutrition. Our findings suggest that NOTES-SASJ followed by OAGB may effectively replicate the metabolic benefits of traditional bypass surgery while ensuring animal safety as a staged procedure. This novel approach could potentially enhance patient acceptance of bariatric procedures.

The staged NOTES-GB technique demonstrates promise in managing DM and obesity, warranting further investigation in clinical settings. Future studies will assess its efficacy in human trials, aiming to revolutionize minimally invasive bariatric surgery.