A novel percutaneous magnetically guided gastrostomy technique without endoscopy or imaging guidance: a feasibility study in a porcine model

Eduardo Aimore Bonin, Paulo Roberto Walter Ferreira, Marcelo de Paula Loureiro, Thais Andrade Costa-Casagrande, Paolo de Oliveira Salvalaggio, Guilherme Francisco Gomes, Rafael William Noda, Christopher John Gostout, Leandro Totti Cavazzola

Research output: Contribution to journalArticle

Abstract

Background: In order to simplify a percutaneous gastrostomy procedure and avoid the need of endoscopy or imaging methods, a novel percutaneous magnetically guided gastrostomy (PMG) technique was conceived. The aim of the present study is to evaluate the feasibility of a novel PMG technique with no endoscopy or any imaging guidance in a porcine model. Methods: Fourteen crossbred domestic pigs were used for prototype development (cadaveric experiments) and proof-of concept, survival study. The magnetic device was conceived using commercially available rare-earth neodymium-based magnets. The experimental design consisted of developing an internal magnetic gastric tube prototype to be orally inserted and coupled to an external magnet placed on the skin, which facilitated stomach and abdominal wall apposition for blind percutaneous gastrostomy tube placement. Then, a gastrostomy tube was percutaneously and blindly placed. Results: Twelve procedures were undertaken in animal cadavers and two in live models. The technique chosen consisted of using a magnetic gastric tube prototype using six 1 × 1-cm-ring magnets attached to its end. This device enabled successful magnetic coupling with a large (5 cm in diameter) magnet disc placed on the skin. For gastric tube placement, a direct trocar insertion allowed easier and safer placement of a gastric tube as compared to a needle-guide-wire dilation (Seldinger-based) technique. Gastropexy was added to avoid early gastric tube displacement. This novel PMG technique was feasible in a live model experiment. Conclusions: A novel magnetically guided percutaneous gastrostomy tube insertion technique without the use of endoscopy or image-guidance was successful in a porcine model. A non-inferiority experimental controlled study comparing this technique to percutaneous endoscopic gastrostomy is needed to confirm its efficacy and safety.

Original languageEnglish (US)
Pages (from-to)4688-4697
Number of pages10
JournalSurgical endoscopy
Volume32
Issue number11
DOIs
StatePublished - Nov 1 2018

Keywords

  • Magnet
  • Percutaneous endoscopic gastrostomy
  • Surgical device
  • Surgical technique

ASJC Scopus subject areas

  • Surgery

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  • Cite this

    Bonin, E. A., Ferreira, P. R. W., de Paula Loureiro, M., Costa-Casagrande, T. A., de Oliveira Salvalaggio, P., Gomes, G. F., Noda, R. W., Gostout, C. J., & Cavazzola, L. T. (2018). A novel percutaneous magnetically guided gastrostomy technique without endoscopy or imaging guidance: a feasibility study in a porcine model. Surgical endoscopy, 32(11), 4688-4697. https://doi.org/10.1007/s00464-018-6335-5