Obesity: Jagannath SB

Anonymous00176, Anderson MA, Gan SI, Fanelli RD, Baron TH, Banerjee S, Cash BD, Dominitz JA, Harrison ME, Ikenberry SO, Jagannath SB, Lichtenstein DR, Shen B, Lee KK, Van Guilder T, Stewart LE. · No affiliation provided · Gastrointest Endosc. · Pubmed #18577471 No free full text.

This publication has no abstract.

Kantsevoy SV, Hu B, Jagannath SB, Isakovich NV, Chung SS, Cotton PB, Gostout CJ, Hawes RH, Pasricha PJ, Nakajima Y, Kawashima K, Kalloo AN. · Division of Gastroenterology, Johns Hopkins University, 1830 E. Monument Street, Baltimore, MD 21205, USA. · Gastrointest Endosc. · Pubmed #17321257 No free full text.

Abstract: 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.

Kantsevoy SV, Niiyama H, Jagannath SB, Chung SS, Cotton PB, Gostout CJ, Hawes RH, Pasricha PJ, Magee CA, Vaughn CA, Barlow D, Kawano H, Shimonaka H, Kalloo AN. · Division of Gastroenterology, Johns Hopkins Hospital, 1830 E. Monument Street, Baltimore, MD 21205, USA. · Gastrointest Endosc. · Pubmed #16733125 No free full text.

Abstract: BACKGROUND: Localization of the proximal jejunum is important for creation of gastrojejunal anastomosis to palliate gastric outlet obstruction or for treatment of obesity with gastric bypass. OBJECTIVE: To facilitate identification of the proximal jejunum during transgastric endoscopic gastrojejunostomy with the use of an endoscopic transilluminator (ET). DESIGN AND SETTING: Acute experiments in a live porcine model. INTERVENTIONS: The ET is a 3500-mm long, 6F radio-opaque tube with a fiberoptic core that lights up at its distal end. When situated in the intestinal lumen, it transilluminates the bowel wall. With the animal under general anesthesia with endotracheal intubation, a colonoscope was advanced to the proximal jejunum. A plastic tube (3500-mm long, 3.5 mm in diameter) was passed through the biopsy channel and placed into the small bowel. The colonoscope was withdrawn, leaving the tube in place. The ET was introduced into the jejunum through the tube. A gastric wall incision was made and the endoscope was advanced to the peritoneal cavity. The transilluminated loop of the proximal jejunum was identified and gastrojejunal anastomosis was made by use of a previously reported endoscopic technique. MAIN OUTCOME MEASUREMENTS: Identification of the proximal jejunum. RESULTS: Eleven pigs (average weight 55 kg) had ET placement. In all of the pigs, placement of the ET was performed easily to the proximal small bowel, and the proximal jejunum was successfully localized by either direct visualization of the transilluminated loop only or with the aid of fluoroscopy. The tip of the ET was usually located about 50 to 70 cm distal to the ligament of Treitz. There were no complications related to the use of ET. LIMITATIONS: The device has not yet been evaluated in humans. CONCLUSIONS: The ET is a safe instrument and can be used to identify the proximal jejunum to facilitate endoscopic gastrojejunostomy.