Endosonography-guided suture device for gastrointestinal lumen-to-lumen apposition in a porcine model.

Background and Aims: The ability to effectively tether 2 separate lumens would simplify performance of transluminal therapeutic endoscopic ultrasound (EUS). This article describes a novel device permitting simple and effective luminal apposition under EUS guidance. Methods: A porcine preclinical study using 1 domestic pig was performed to show proof-of-concept of a novel suturing device that can be deployed with EUS to appose the gallbladder wall to the stomach. The goal is to facilitate a simple and straightforward approach to cholecystogastrostomy using a lumen-apposing metal stent. Results: EUS was performed to identify the porcine gallbladder. The device was used to puncture across the gastric wall and into the gallbladder. Once needle access was obtained, 4 flexible braided suture tags were extruded over a 3-0 polypropylene suture into the gallbladder lumen. Upon applying suture tension, the tags bunch to form a secure loop within the gallbladder lumen. With tension on this suture, the gallbladder may be brought up to the gastric wall and the transmural 3-0 suture then cinched at the gastric mucosa to effect durable luminal apposition. After this, cholecystogastrostomy with an electrocautery-enhanced lumen-apposing metal stent was performed using a standard freehand technique. Conclusions: A novel EUS-guided suturing device permits apposition of the porcine gallbladder and stomach, facilitating EUS-guided transmural gallbladder drainage. This approach may affect the safety and technical success rates of novel translumenal therapeutic EUS procedures.