Gastrojejunal stomal reduction with the T-tag device in porcine models (with videos)

Shou jiang Tang, Christopher O. Olukoga, David A. Provost, Deborah Hogg, Edward Livingston, Daniel J. Scott

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background: Roux-en-Y gastric bypass is the most commonly performed bariatric operation in the United States. Gastrojejunal (GJ) stomal dilatation associated with weight regain is a late complication. Surgical revision is usually required for stomal or pouch reduction. Objective: Our purpose was to evaluate the technical feasibility, efficacy, and safety of stomal reduction with endoscopic T-tag devices. Design: Prospective nonsurvival studies were conducted in pigs (n = 2, 110 pounds each). Interventions: Three GJ stomas were created in each pig through a midline laparotomy by using circular staplers. Endoscopic GJ stomal reduction/revision was performed on these newly created stomas with an Olympus T-tag device. Necropsy was performed to examine the deployed T-tag locations and procedure-related adjacent tissue/organ injury and to assess the effectiveness of stomal reduction. Results: Endoscopic stomal revision was performed on 5 stomas with moderate stomal reduction. One GJ stoma could not be accessed easily by endoscopy because of the small size of the gastric pouch. An average of 4 T-tag devices was deployed around each stoma. The procedural time was about 61 ± 12 minutes for each stomal reduction. Overall, 26 of 39 (66.7%) T-bars were deployed in accepted locations. The stomas were reduced from 1.60 ± 0.21 mm × 1.44 ± 0.14 mm to 1.28 ± 0.29 mm × 0.98 ± 0.17 mm and the percentage of stomal reduction was 27.3% ± 13.3%. In the end, a therapeutic gastroscope could not be advanced through the reduced stomas. In 2 stomas, 5 of 39 (12.8%) T-bars injured or attached to the adjacent organs: isolated stomach and abdominal wall. Limitation: Nonsurvival pig studies. Conclusions: Endoscopic stomal reduction with T-tag device is technically feasible and effective in two thirds of trials. However, it is associated with a small risk of adjacent organ/tissue injury with the current prototype device and deployment method.

Original languageEnglish (US)
Pages (from-to)132-138
Number of pages7
JournalGastrointestinal Endoscopy
Volume68
Issue number1
DOIs
StatePublished - Jul 2008

Fingerprint

Swine
Equipment and Supplies
Stomach
Gastroscopes
Bariatrics
Gastric Bypass
Wounds and Injuries
Abdominal Wall
Reoperation
Laparotomy
Endoscopy
Dilatation
Prospective Studies
Safety
Weights and Measures
Therapeutics

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Gastrojejunal stomal reduction with the T-tag device in porcine models (with videos). / Tang, Shou jiang; Olukoga, Christopher O.; Provost, David A.; Hogg, Deborah; Livingston, Edward; Scott, Daniel J.

In: Gastrointestinal Endoscopy, Vol. 68, No. 1, 07.2008, p. 132-138.

Research output: Contribution to journalArticle

Tang, Shou jiang ; Olukoga, Christopher O. ; Provost, David A. ; Hogg, Deborah ; Livingston, Edward ; Scott, Daniel J. / Gastrojejunal stomal reduction with the T-tag device in porcine models (with videos). In: Gastrointestinal Endoscopy. 2008 ; Vol. 68, No. 1. pp. 132-138.
@article{486b44c3ed20408d8a61b777051237f3,
title = "Gastrojejunal stomal reduction with the T-tag device in porcine models (with videos)",
abstract = "Background: Roux-en-Y gastric bypass is the most commonly performed bariatric operation in the United States. Gastrojejunal (GJ) stomal dilatation associated with weight regain is a late complication. Surgical revision is usually required for stomal or pouch reduction. Objective: Our purpose was to evaluate the technical feasibility, efficacy, and safety of stomal reduction with endoscopic T-tag devices. Design: Prospective nonsurvival studies were conducted in pigs (n = 2, 110 pounds each). Interventions: Three GJ stomas were created in each pig through a midline laparotomy by using circular staplers. Endoscopic GJ stomal reduction/revision was performed on these newly created stomas with an Olympus T-tag device. Necropsy was performed to examine the deployed T-tag locations and procedure-related adjacent tissue/organ injury and to assess the effectiveness of stomal reduction. Results: Endoscopic stomal revision was performed on 5 stomas with moderate stomal reduction. One GJ stoma could not be accessed easily by endoscopy because of the small size of the gastric pouch. An average of 4 T-tag devices was deployed around each stoma. The procedural time was about 61 ± 12 minutes for each stomal reduction. Overall, 26 of 39 (66.7{\%}) T-bars were deployed in accepted locations. The stomas were reduced from 1.60 ± 0.21 mm × 1.44 ± 0.14 mm to 1.28 ± 0.29 mm × 0.98 ± 0.17 mm and the percentage of stomal reduction was 27.3{\%} ± 13.3{\%}. In the end, a therapeutic gastroscope could not be advanced through the reduced stomas. In 2 stomas, 5 of 39 (12.8{\%}) T-bars injured or attached to the adjacent organs: isolated stomach and abdominal wall. Limitation: Nonsurvival pig studies. Conclusions: Endoscopic stomal reduction with T-tag device is technically feasible and effective in two thirds of trials. However, it is associated with a small risk of adjacent organ/tissue injury with the current prototype device and deployment method.",
author = "Tang, {Shou jiang} and Olukoga, {Christopher O.} and Provost, {David A.} and Deborah Hogg and Edward Livingston and Scott, {Daniel J.}",
year = "2008",
month = "7",
doi = "10.1016/j.gie.2008.02.022",
language = "English (US)",
volume = "68",
pages = "132--138",
journal = "Gastrointestinal Endoscopy",
issn = "0016-5107",
publisher = "Mosby Inc.",
number = "1",

}

TY - JOUR

T1 - Gastrojejunal stomal reduction with the T-tag device in porcine models (with videos)

AU - Tang, Shou jiang

AU - Olukoga, Christopher O.

AU - Provost, David A.

AU - Hogg, Deborah

AU - Livingston, Edward

AU - Scott, Daniel J.

PY - 2008/7

Y1 - 2008/7

N2 - Background: Roux-en-Y gastric bypass is the most commonly performed bariatric operation in the United States. Gastrojejunal (GJ) stomal dilatation associated with weight regain is a late complication. Surgical revision is usually required for stomal or pouch reduction. Objective: Our purpose was to evaluate the technical feasibility, efficacy, and safety of stomal reduction with endoscopic T-tag devices. Design: Prospective nonsurvival studies were conducted in pigs (n = 2, 110 pounds each). Interventions: Three GJ stomas were created in each pig through a midline laparotomy by using circular staplers. Endoscopic GJ stomal reduction/revision was performed on these newly created stomas with an Olympus T-tag device. Necropsy was performed to examine the deployed T-tag locations and procedure-related adjacent tissue/organ injury and to assess the effectiveness of stomal reduction. Results: Endoscopic stomal revision was performed on 5 stomas with moderate stomal reduction. One GJ stoma could not be accessed easily by endoscopy because of the small size of the gastric pouch. An average of 4 T-tag devices was deployed around each stoma. The procedural time was about 61 ± 12 minutes for each stomal reduction. Overall, 26 of 39 (66.7%) T-bars were deployed in accepted locations. The stomas were reduced from 1.60 ± 0.21 mm × 1.44 ± 0.14 mm to 1.28 ± 0.29 mm × 0.98 ± 0.17 mm and the percentage of stomal reduction was 27.3% ± 13.3%. In the end, a therapeutic gastroscope could not be advanced through the reduced stomas. In 2 stomas, 5 of 39 (12.8%) T-bars injured or attached to the adjacent organs: isolated stomach and abdominal wall. Limitation: Nonsurvival pig studies. Conclusions: Endoscopic stomal reduction with T-tag device is technically feasible and effective in two thirds of trials. However, it is associated with a small risk of adjacent organ/tissue injury with the current prototype device and deployment method.

AB - Background: Roux-en-Y gastric bypass is the most commonly performed bariatric operation in the United States. Gastrojejunal (GJ) stomal dilatation associated with weight regain is a late complication. Surgical revision is usually required for stomal or pouch reduction. Objective: Our purpose was to evaluate the technical feasibility, efficacy, and safety of stomal reduction with endoscopic T-tag devices. Design: Prospective nonsurvival studies were conducted in pigs (n = 2, 110 pounds each). Interventions: Three GJ stomas were created in each pig through a midline laparotomy by using circular staplers. Endoscopic GJ stomal reduction/revision was performed on these newly created stomas with an Olympus T-tag device. Necropsy was performed to examine the deployed T-tag locations and procedure-related adjacent tissue/organ injury and to assess the effectiveness of stomal reduction. Results: Endoscopic stomal revision was performed on 5 stomas with moderate stomal reduction. One GJ stoma could not be accessed easily by endoscopy because of the small size of the gastric pouch. An average of 4 T-tag devices was deployed around each stoma. The procedural time was about 61 ± 12 minutes for each stomal reduction. Overall, 26 of 39 (66.7%) T-bars were deployed in accepted locations. The stomas were reduced from 1.60 ± 0.21 mm × 1.44 ± 0.14 mm to 1.28 ± 0.29 mm × 0.98 ± 0.17 mm and the percentage of stomal reduction was 27.3% ± 13.3%. In the end, a therapeutic gastroscope could not be advanced through the reduced stomas. In 2 stomas, 5 of 39 (12.8%) T-bars injured or attached to the adjacent organs: isolated stomach and abdominal wall. Limitation: Nonsurvival pig studies. Conclusions: Endoscopic stomal reduction with T-tag device is technically feasible and effective in two thirds of trials. However, it is associated with a small risk of adjacent organ/tissue injury with the current prototype device and deployment method.

UR - http://www.scopus.com/inward/record.url?scp=45249110915&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=45249110915&partnerID=8YFLogxK

U2 - 10.1016/j.gie.2008.02.022

DO - 10.1016/j.gie.2008.02.022

M3 - Article

C2 - 18577481

AN - SCOPUS:45249110915

VL - 68

SP - 132

EP - 138

JO - Gastrointestinal Endoscopy

JF - Gastrointestinal Endoscopy

SN - 0016-5107

IS - 1

ER -