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

BACKGROUND 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. OBJECTIVE Direct EUS-guided cholecysto-gastrostomy with placement of a double flanged expandable metal stents. DESIGN/SETTING This was an animal pilot/feasibility study. INTERVENTIONS 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. RESULT The results showed the feasibility of EUS-guided cholecysto-gastrostomy based on prototype devices for access in the gallbladder and transgastric stent placement. LIMITATIONS Survival feasibility study with prototype devices in a small number of animals. CONCLUSIONS 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. ABBREVIATIONS NOTES - Natural Orifice Translumenal Endoscopic Surgery; EUS - Endoscopic Ultrasound; EUSFNA - Endoscopic Ultrasound Fine Needle Aspiration.