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 cholecystogastrostomy 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.