Christopher J. Gostout

Mayo Clinic - Rochester, Rochester, Minnesota, United States

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Publications (318)1656.23 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Our previous work revealed significantly less acidosis in swine undergoing natural orifice translumenal endoscopic surgery (NOTES) using endoscopic air insufflation than swine undergoing standard laparoscopy. We wanted to evaluate the differential effects of CO2 versus intra-abdominal pressure as source for this finding. In addition, we investigated the endocrine stress response between swine undergoing NOTES peritoneoscopy with CO2 insufflation and animals undergoing standard diagnostic laparoscopy with CO2. Twenty-eight (28) female 50-kg domestic pigs were randomly assigned to one of four groups using a permuted block randomization table: Group 1: NOTES using CO2 insufflation, Group 2: NOTES using air insufflation, Group 3: laparoscopy max pressure 12 mmHg and Group 4: laparoscopy with max pressure 7 mmHg. Invasive monitoring lines were placed. Pneumoperitoneum was established by the respective method and maintained for 90 min, visualizing liver, spleen and colon. Arterial blood gas was obtained at baseline and four additional time points. Serum TNF-α for POD (postoperative day) 1 and cumulative urine adrenaline for the procedure were determined by ELISA. ANOVA and t test were used for statistical comparison. The study was Institutional Animal Care and Use Committees approved. All experiments were completed as outlined. Blood pH showed a significant difference between groups. Serum TNF-α revealed higher levels for NOTES CO2 on POD 1 than standard laparoscopy (p = 0.03). NOTES animals with CO2 insufflation initially experienced similar pH compared to standard laparoscopy but recovered to levels seen in low-pressure laparoscopy and NOTES with air. NOTES with CO2 appears to elicit a stronger stress response in this study than standard or low-pressure laparoscopy or NOTES with air.
    Surgical endoscopy. 02/2015;
  • Uzma D Siddiqui, Christopher J Gostout
    Gastrointestinal Endoscopy Clinics of North America 01/2015; 25(1):xiii-xiv.
  • Kohei Takizawa, Mary A. Knipschield, Christopher J. Gostout
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    ABSTRACT: Endoscopic full-thickness resection (EFTR) is commonly performed with laparoscopic assistance. Submucosal endoscopy with full-thickness resection (SEFTR) is a new technique that combines submucosal endoscopy with the mucosal safety valve flap method to enable EFTR. Pilot evaluation of the feasibility and safety of SEFTR in an animal model. In vivo animal study. Developmental endoscopy unit/animal research unit. Five domestic pigs, under general anesthesia, were used. A 2-cm gastric target area was marked. A circumferential mucosal incision was made. Two parallel submucosal tunnels on opposite sides of the incision were made. The mucosa at the proximal and distal tunnel ends was cut. A suture was passed through the tunnels encircling the target. T bars with sutures were placed full thickness outside the target and brought out of the mouth. Pulling the oral sutures raised the target while the targeted area was cinched serosa to serosa with the encircling suture. Full-thickness excision was then performed without closure. Rate of adverse events, procedure times, adverse events, and difficulty scales were recorded prospectively. Circumferential mucosal incisions, submucosal tunnels, and connections were completed in all. In the first case, looping of the target lesion failed. In the remaining 4 cases, looping, cinching, and lifting were completed. Full-thickness resections were completed in 3 of 4 pigs. There were no procedural adverse events and no damage to adjacent organs. Acute animal study. Procedures were performed by an endoscopist skilled in the submucosal endoscopy with the mucosal safety valve flap method. This pilot experience suggests that SEFTR is feasible and could be safe. Copyright © 2014 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
    Gastrointestinal Endoscopy 11/2014; · 4.90 Impact Factor
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    ABSTRACT: The field of bariatric surgery has been rapidly growing and evolving over the past several decades. During the period that obesity has become a worldwide epidemic, new interventions have been developed to combat this complex disorder. The development of new laparoscopic and minimally invasive treatments for medically-complicated obesity has made it essential that gastrointestinal physicians obtain a thorough understanding of past developments and possible future directions in bariatrics. New laparoscopic advancements provide patients and practitioners with a variety of options that have an improved safety profile and better efficacy without open, invasive surgery. The mechanisms of weight loss after bariatric surgery are complex and may in part be related to altered release of regulatory peptide hormones from the gut. Endoscopic techniques designed to mimic the effects of bariatric surgery and endolumenal interventions performed entirely through the gastrointestinal tract offer potential advantages. Several of these new techniques have demonstrated promising, preliminary results. We outline herein historical and current trends in the development of bariatric surgery and its transition to safer and more minimally invasive procedures designed to induce weight loss.
    World journal of gastroenterology : WJG. 10/2014; 20(37):13424-13445.
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    ABSTRACT: A subset of patients with non-variceal gastrointestinal bleeding fail, or are unsuitable candidates for, endoscopic, radiologic, and surgical interventions. Endoscopic ultrasound (EUS)-guided intervention might be effective in these patients. We performed EUS-guided hemostatic interventions for 17 patients with non-variceal gastrointestinal bleeding from June 2003 through May 2014 who failed, or were unsuitable candidates for, additional therapies. Indications for treatment included gastrointestinal stromal tumors, colorectal vascular malformations, duodenal masses or polyps, Dieulafoy lesions, duodenal ulcers, rectally invasive prostate cancer, pancreatic pseudoaneurysms, ulcerated esophageal cancer, and ulceration following Roux-en-Y gastric bypass. Following the procedure, 88% of patients have had no further bleeding related to the treated lesion, over a median follow-up period of 12 months. EUS-guided hemostatic therapy is therefore feasible and useful for select patients with clinically severe, refractory, or recurrent non-variceal gastrointestinal bleeding.
    Clinical Gastroenterology and Hepatology 09/2014; · 6.53 Impact Factor
  • Gastrointestinal Endoscopy 06/2014; 28(7). · 4.90 Impact Factor
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    ABSTRACT: Data comparing operative and endoscopic resection of adenomas of the ampulla of Vater are limited. Our aims were to evaluate and compare the long-term results and outcomes of endoscopic and operative resections of benign tumors of the ampulla of Vater as well as to determine which features of benign periampullary neoplasms would predict recurrence or failure of endoscopic therapy and therefore need for operative treatment.
    Journal of Gastrointestinal Surgery 06/2014; · 2.39 Impact Factor
  • Kohei Takizawa, Mary a. Knipschield, Christopher J. Gostout
    Gastrointestinal Endoscopy 05/2014; 79(5):AB256. · 4.90 Impact Factor
  • Kazuki Sumiyama, Christopher J Gostout, Hisao Tajiri
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    ABSTRACT: Submucosal endoscopy with a mucosal flap (SEMF) safety valve technique is a global concept in which the submucosa is a free working space for endoscopic interventions. A purposefully created intramural space provides an endoscopic access route to the deeper layers and into the extraluminal cavities. The mucosa overlying the intramural space is protective, reducing contamination during natural orifice transluminal endoscopic surgery (NOTES) procedures and providing a sealant flap to repair the entry point and the submucosal space. In addition to NOTES, SEMF enables endoscopic achalasia myotomy, histologic analysis of the muscularis propria, and submucosal tumor removal.
    Gastrointestinal endoscopy clinics of North America 04/2014; 24(2):265-272.
  • Nabeel Azeem, Christopher J Gostout, Mary Knipschield, Todd H Baron
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    ABSTRACT: Patients with primary sclerosing cholangitis (PSC) have an increased lifetime risk of cholangiocarcinoma (CCA). Detection of localized CCA in patients with PSC may result in curative liver transplantation. Recently, high-resolution per-oral video cholangioscopy (PVCS) has become available and may be useful for evaluating for biliary dysplasia. Narrow-band imaging (NBI) has shown promising results in detecting dysplasia in the esophagus and colon, but its utility in the bile duct is unproven. Evaluate NBI video PVCS in screening for dysplasia in patients with PSC. Prospective case series. Tertiary-care referral center. Patients with PSC undergoing ERCP between December 2008 and July 2010. ERCP with white-light and NBI PVCS and biopsy of suspicious lesions. Dysplasia detection. A total of 30 patients were enrolled. Median follow-up was 319.5 days. Four patients had a final diagnosis of CCA (2 extrahepatic, 2 intrahepatic). NBI visualized the 2 extrahepatic CCAs and allowed determination of tumor margins. The bile duct mucosa by NBI visual appearance in patients with PSC was variable. No correlation with CCA development could be determined. There was a 48% increase in suspicious lesions biopsied with NBI compared with white-light imaging, although NBI-directed biopsies did not improve the dysplasia detection rate. Small sample size, single center, referral bias. NBI allowed visualization of tumor margins in CCA as compared with traditional fluoroscopy-based ERCP. An improvement in dysplasia detection in patients with PSC could not be demonstrated despite an increase in the biopsy rate. Additional experience is needed to assess the utility of NBI in screening for CCA in patients with PSC. (Clinical trial registration number: NCT00951327.).
    Gastrointestinal endoscopy 10/2013; · 4.90 Impact Factor
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    ABSTRACT: Staging peritoneoscopy is typically done by laparoscopy in the operating room. Natural orifice transluminal endoscopic surgery peritoneoscopy is an appealing alternative to the current approach. Transcolonic submucosal endoscopy with mucosal flap (SEMF) may provide natural orifice transluminal endoscopic surgery peritoneoscopy. The aim was to verify the feasibility and safety of transcolonic peritoneoscopy with SEMF (TCPS) in a porcine survival model. Survival study. Animal research unit. Seven target beads were placed in the peritoneal cavity by laparoscopy in each of 6 animals, and TCPS was performed to identify and touch beads to simulate biopsy. Animals were euthanized after 1 week, at which time, laparotomy was performed and the SEMF site was resected for histological analysis. The number of beads identified and touched during peritoneoscopy, rate of successful completion of TCPS, procedure time, mortality equivalent 1 week after TCPS, adverse event rate, histological assessment of SEMF site. All 7 beads in all 6 pigs were identified and touched during TCPS. The success rate of TCP was 100%. No major adverse events occurred during the procedure. The median procedure times for the creation of a submucosal tunnel, peritoneoscopy, closure of mucosal incision, and entire procedure were 19.5, 17, 9.5, and 45 minutes, respectively. All pigs survived until euthanasia, and there was no evidence of peritonitis or severe infection. Animal study, single endoscopist, small sample size. Results of this study indicate that TCPS is feasible and safe in a porcine survival model.
    Gastrointestinal endoscopy 08/2013; · 4.90 Impact Factor
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    ABSTRACT: Minimum training for capsule endoscopy (CE) is based on societal guidelines and expert opinion. Objective measures of competence are lacking. Our objectives were to (1) establish structured CE training curriculum during a gastroenterology fellowship, (2) develop a formalized assessment tool to evaluate CE competency, (3) prospectively analyze trainee CE competency, (4) define metrics for trainee CE competence by using comparative data from CE staff, and (5) determine the correlation between CE competence and previous endoscopy experience. Single-center, prospective analysis over 6 years. Tertiary academic center. Gastroenterology fellows and CE staff. Structured CE training was implemented with supervised CE interpretation. Capsule Competency Test (CapCT) was developed and data collected on the number of CEs, upper endoscopies, colonoscopies, and push enteroscopies performed. Trainee competence defined as CapCT score 90% or higher of the mean staff score. A total of 39 fellows completed CE training and CapCT. Fellows were grouped according to number of completed CE interpretations: 10 or fewer (n = 13), 11 to 20 (n = 19), and 21 to 35 (n = 7). Eight CE staff completed CapCT with a mean score of 91%. Mean scores for trainees with fewer than 10, 11 to 20, and 21 to 35 CE interpretations were 79%, 79%, and 85%, respectively. A significant difference was seen between staff and fellow scores with 10 or fewer and 11 to 20 interpretations (P < .001). No correlation was found between trainee scores and previous endoscopy experience. Single center. Using a structured CE training curriculum, we defined competency in CE interpretation by using the CapCT. Based on these findings, trainees should complete more than 20 CE studies before assessing competence, regardless of previous endoscopy experience.
    Gastrointestinal endoscopy 07/2013; · 4.90 Impact Factor
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    ABSTRACT: EUS can provide access to the main pancreatic duct (MPD) for therapeutic intervention. The long-term clinical success of EUS-guided MPD interventions is unknown. To determine technical and clinical success rates, predictors of success, and long-term outcomes of EUS-guided MPD intervention. Retrospective, single-center study. Tertiary-care referral center. Forty-five patients. EUS-guided MPD stent retrieval or placement. Technical and clinical success rates, adverse events, and long-term clinical outcomes. Among the 45 patients, 37 had undergone failed ERCP, and 29 had surgically altered anatomy. Median follow-up after initial EUS-guided intervention was 23 months. Two patients underwent EUS for stent removal, and EUS-guided MPD stent placement was attempted in 43 patients. Technical success was achieved in 32 of 43 patients (74%) with antegrade (n = 18) or retrograde (n = 14) stent insertion. Serious adverse events occurred in 3 patients (6%). Patients underwent a median of 2 (range 1-6) follow-up procedures for revision or removal of stents, without adverse events. Complete symptom resolution occurred in 24 of 29 patients (83%) while stents were in place, including all 6 with nondilated ducts. Stents were removed in 23 patients, who were then followed for an additional median of 32 months; 4 patients had recurrent symptoms. Among the 11 failed cases, most had persistent symptoms or required surgery. Retrospective study design, individualized patient management. EUS-guided MPD intervention is feasible and safe, with long-term clinical success in the majority of patients. EUS provides important treatment options, particularly in patients who would otherwise undergo surgery.
    Gastrointestinal endoscopy 07/2013; · 4.90 Impact Factor
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    Gastrointestinal endoscopy 07/2013; · 4.90 Impact Factor
  • Kohei Takizawa, Mary A Knipschield, Christopher J Gostout
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    ABSTRACT: We developed a technique, submucosal endoscopy with mucosal resection (SEMR) intended to make endoscopic submucosal dissection easier and safer. With this technique, the submucosal layer is balloon dissected in lieu of electrosurgical knife dissection. The aim of this study was to further evaluate SEMR in the porcine rectum and colon. Targeted sites in the rectum and the distal colon were marked by spot coagulation. Submucosal fluid cushions (SFC) were created followed by a circumferential mucosal incision. After isolation of the targeted mucosa, balloon dissection was initiated. The balloon catheter was inserted deep into SFC and the inflated balloon repeatedly pulled back toward the endoscope tip to disrupt the submucosa. Residual strands of submucosa were cut. Dissection difficulty scores (DDS) were used using a visual analogue scale ranging from 0 to 5 (failed). The entire study period was divided into three periods (first period, pigs 1-10; second period, pigs 11-20; third period, pigs 21-30). Sixty lesions in 30 pigs were resected using SEMR. The en block resection rate was 95 %. There were three incomplete resections, two as a result of an errant site location and one as a result of a floppy prototype balloon catheter tip. The median resected size, procedure time, and DDS were 6.0 cm, 25 min, and 1. All three failed cases occurred in first period. The procedure time in third period was significantly shorter than the second period (P = 0.0017). The DDS in first period was significantly higher than the second (P = 0.0024) and third (P = 0.0155) periods. Two perforations, one muscularis propria catheter perforation, and one mucosal perforation were observed (3.3 %). Large mucosal target sites in the rectum and distal colon could be safely removed en bloc by means of a hybrid technique, SEMR, with blunt submucosal balloon dissection.
    Surgical Endoscopy 07/2013; · 3.31 Impact Factor
  • Christopher J. Gostout
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    ABSTRACT: Submucosal endoscopy with saftey valve mucosal flap was developed in the animal laboratory of the Mayo Clinic Developmental Endoscopy Unit. This concept, and ultimately clinical technique, was an outgrowth of earlier efforts to improve endoscopic excision of mucosal disease by manipulating the submucosa. The ability of the mucosa to readily separate from the submucosa (delaminate) was the critical observation that was refined into a method transforming the submucosa into a working space while allowing the overlying mucosal flap to serve as a protective barrier.
    Techniques in Gastrointestinal Endoscopy 07/2013; 15(3):127–130.
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    ABSTRACT: Background and study aims: Removal of a lesion containing an ulcer scar is one of the most challenging applications of endoscopic submucosal dissection (ESD). The present study examined whether a novel balloon dissector could cleave fibrotic submucosal tissue beneath ulcer scars.Methods: Six pigs were studied. Endoscopic mucosal resection (EMR) with ligation was performed at 7 or 8 sites in the stomach for each animal; 4 weeks later, 23 sites with a visible scar were selected for submucosal dissection. The procedure involved first creating a submucosal fluid cushion (SFC) by injecting either saline mixed with mesna or pure saline. A slender, compliant balloon with a diameter of 8, 13, or 18 mm was inserted into the SFC. The balloon was unfolded and thrust forward to cleave the fibrotic submucosa over approximately 5 cm.Results: Fibrotic submucosa was dissected within 90 seconds in 17 of 23 attempts. Isolating the ulcer scar from the muscularis with the SFC prior to balloon dissection and using a thinner balloon catheter both ensured a better dissection.Conclusions: The fibrotic submucosa underlying post-EMR scars can be dissected with the novel balloon dissector, although the technique is less effective in cases with no sign of lifting.
    Endoscopy 06/2013; · 5.20 Impact Factor
  • Barham K Abu Dayyeh, Elizabeth Rajan, Christopher J Gostout
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    ABSTRACT: BACKGROUND: Obesity and its associated conditions, including type 2 diabetes and cardiovascular disease, have reached epidemic proportions. High-efficacy, high-risk surgical approaches are unlikely to meet the increasing burden of disease. Emerging endoscopic technologies have opened the door for endoscopic approaches to reproduce many of the benefits of GI weight loss surgery and thereby contribute to the effective treatment of obesity and its associated disorders. OBJECTIVE: To demonstrate the technical feasibility of transoral endoscopic gastric volume reduction with an endoscopic suturing device in a fashion similar to sleeve gastrectomy for the treatment of obesity. DESIGN: Single-center, pilot feasibility study. PATIENTS: Four human subjects with obesity. INTERVENTIONS: Transoral sleeve gastroplasty. MAIN OUTCOME MEASUREMENTS: Technical feasibility. RESULTS: We successfully used an endoscopic free-hand suturing system in 4 subjects, thus demonstrating the technical feasibility of a novel technique to mimic the anatomic manipulations created by surgical sleeve gastrectomy endoscopically. LIMITATIONS: Pilot feasibility study with small number of subjects. CONCLUSIONS: Endoscopic sleeve gastroplasty for treatment of obesity is feasible.
    Gastrointestinal endoscopy 05/2013; · 4.90 Impact Factor
  • Gastrointestinal Endoscopy 05/2013; 77(5):AB194. · 4.90 Impact Factor
  • Gastrointestinal endoscopy 02/2013; · 4.90 Impact Factor

Publication Stats

8k Citations
1,656.23 Total Impact Points


  • 1989–2014
    • Mayo Clinic - Rochester
      • • Department of Gastroenterology and Hepatology
      • • Department of Hospital Internal Medicine
      Rochester, Minnesota, United States
  • 1987–2013
    • Mayo Foundation for Medical Education and Research
      • • Department of Surgery
      • • Division of Gastroenterology and Hepatology
      • • Mayo Medical School
      Jacksonville, FL, United States
  • 2005–2012
    • Johns Hopkins Medicine
      • Department of Medicine
      Baltimore, MD, United States
  • 2008–2011
    • The Jikei University School of Medicine
      • Department of Endoscopy
      Tokyo, Tokyo-to, Japan
    • University Medical Center Utrecht
      • Department of Gastroenterology and Hepatology
      Utrecht, Utrecht, Netherlands
  • 2009
    • Dartmouth–Hitchcock Medical Center
      Lebanon, New Hampshire, United States
  • 2005–2008
    • Beth Israel Deaconess Medical Center
      • Division of Gastroenterology
      Boston, Massachusetts, United States
  • 1992–2008
    • University of Minnesota Rochester
      Rochester, Minnesota, United States
  • 2007
    • University of Texas Medical Branch at Galveston
      Galveston, Texas, United States
    • Second Military Medical University, Shanghai
      Shanghai, Shanghai Shi, China
    • Taichung Veterans General Hospital
      臺中市, Taiwan, Taiwan
  • 2005–2007
    • Johns Hopkins University
      • Division of Gastroenterology
      Baltimore, MD, United States
  • 2004
    • Medical University of South Carolina
      • Digestive Disease Center
      Charleston, SC, United States