Development of New Devices for Translumenal Endoscopic Esophageal Anastomosis

Abstract

This study aimed to develop new devices for translumenal endoscopic esophageal anastomosis-a stent and a ligating device-and to confirm the feasibility of our novel procedure using those devices. We designed a ligating device as an overtube whose tip worked like the EVL device (Sumitomo Bakelite Co. Ltd., Tokyo, Japan). The newly developed procedure for anastomosis is as follows: a silicone elastic band, which was released from the device located at the upper esophagus, and a custom-made expandable stent, which was expanded by the balloon catheter in the lower esophagus, tightened the upper and lower esophageal walls. After producing the devices, we performed the anastomosis procedure in porcine models. A ligating device and an expandable stent were developed for this study. An ex vivo feasibility study was performed in three porcine models. Endoscopic visualization revealed that all steps in this procedure were technically successful. The median time needed to perform this procedure was 24 (range, 19-25) minutes. Patency of the anastomosis was confirmed in all specimens. Translumenal esophagoesophageal anastomosis using the new devices was feasible. The procedure time was sufficiently short for clinical use. An in vivo survival study is needed to confirm the safety and reliability of this procedure.