David Barlow

Publications (2)9.76 Total impact

• Article: The endoscopic transilluminator: an endoscopic device for identification of the proximal jejunum for transgastric endoscopic gastrojejunostomy.

  Sergey V Kantsevoy, Hideaki Niiyama, Sanjay B Jagannath, Sydney S C Chung, Peter B Cotton, Christopher J Gostout, Robert H Hawes, Pankaj J Pasricha, Carolyn A Magee, Cheryl A Vaughn, David Barlow, Hironobu Kawano, Hideki Shimonaka, Anthony N Kalloo
  [show abstract] [hide abstract]
  ABSTRACT: 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. To facilitate identification of the proximal jejunum during transgastric endoscopic gastrojejunostomy with the use of an endoscopic transilluminator (ET). Acute experiments in a live porcine model. 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 The colonoscope was withdrawn, leaving the tube in place.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. Identification of the proximal jejunum. 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. The device has not yet been evaluated in humans. The ET is a safe instrument and can be used to identify the proximal jejunum to facilitate endoscopic gastrojejunostomy.
  Gastrointestinal Endoscopy 07/2006; 63(7):1055-8. · 4.88 Impact Factor
• Article: Endoscopic gastrojejunostomy with survival in a porcine model.

  Sergey V Kantsevoy, Sanjay B Jagannath, Hideaki Niiyama, Sydney S C Chung, Peter B Cotton, Christopher J Gostout, Robert H Hawes, Pankaj J Pasricha, Carolyn A Magee, Cheryl A Vaughn, David Barlow, Hideki Shimonaka, Anthony N Kalloo
  [show abstract] [hide abstract]
  ABSTRACT: We have previously reported the feasibility and the safety of an endoscopic transgastric approach to the peritoneal cavity in a porcine model. We now report successful performance of endoscopic gastrojejunostomy with survival. All procedures were performed on 50-kg pigs, with the pigs under general anesthesia, in aseptic conditions with sterilized endoscopes and accessories. The stomach was irrigated with antibiotic solution, and a gastric incision was performed with a needle-knife and a sphincterotome. A standard upper endoscope was advanced through a sterile overtube into the peritoneal cavity. A loop of jejunum was identified, was retracted into the stomach, and was secured with sutures while using a prototype endoscopic suturing device. An incision was made into the jejunal loop with a needle-knife, and the filet-opened ends of the jejunal wall were secured to the gastric wall with a second line of sutures, completing the gastrojejunostomy. Two pigs survived for 2 weeks. Endoscopy and a radiographic contrast study performed after gastrojejunostomy revealed a patent anastomosis with normal-appearing gastric and jejunal mucosa. Postmortem examination demonstrated a well-healed anastomosis without infection or adhesions. The endoscopic transgastric approach to create a gastrojejunostomy is technically feasible and can be performed, with survival, in a porcine model.
  Gastrointestinal Endoscopy 09/2005; 62(2):287-92. · 4.88 Impact Factor