Technical feasibility of endoscopic gastric reduction: a pilot study in a porcine model

Background: Gastric restrictive procedures are widely used for the surgical treatment of morbid obesity. Objective: Our purpose was to determine the technical feasibility of endoscopic gastric reduction in a live porcine model. Setting: Acute experiments on 50-kg pigs under general anesthesia. Design and Interventions: After per-oral intubation, the endoscope was inserted into the stomach. A fishing line was sutured to the gastric wall along the fundus approximately 5 cm below the gastroesophageal junction with a prototype endoscopic suturing device (Olympus, Eagle Claw). Then the fishing line was tied to create a small proximal pouch. A flexible sheath was placed on one side of fishing line and additional knots were tied, forming a ring at the outlet of the gastric pouch. The ring was anchored to gastric wall with additional stitches, completing the gastric reduction. Then the animals were killed for postmortem examination. Main Outcome Measurements: The feasibility of endoscopic gastric reduction. Results: We performed 4 acute experiments. It required 12 to 14 stitches in each animal to create gastric reduction. There were no technical problems during the procedures. Postmortem examination demonstrated an approximately 30-mL gastric pouch separated from the rest of the stomach by the line of stitches. There were no complications during the procedure. Limitations: We have not performed survival experiments to determine how long our gastric reduction will last. Conclusions: Endoscopic gastric reduction is technically feasible on a live porcine model.