Retrievable puncture anchor traction method for endoscopic ultrasound-guided gastroenterostomy: A porcine study

Figure 1 The retrievable puncture anchor. A: The retrievable puncture anchor (Vedkang Inc., Changzhou, Jiangsu, China) in its entirety; B: The head of the anchor; C and D: A view of the passage of the anchor along the shaft of the puncture needle.

Figure 2 The retrievable puncture anchor traction method. A: Schematic diagram: The bowel is punctured under endoscopic ultrasound (EUS) guidance; B: Endoscopic ultrasound image: The bowel is punctured under EUS guidance; C: Schematic diagram: The retrievable puncture anchor is passed through the needle; D: Endoscopic ultrasound image: The anchor is inserted into the bowel; E: Schematic diagram: After pulling out the needle, the anchor attaches to the bowel; F: Endoscopic ultrasound image: After pulling out the needle, the anchor attaches to the bowel; G: Schematic diagram: The identified small-bowel loop is punctured again under EUS guidance. A guidewire is inserted through the needle. The small bowel is shown being punctured and drained using electrocautery-enhanced delivery of lumen-apposing metal stents over the guidewire; H: Endoscopic ultrasound image: The anchor-grasped bowel is shown under traction for stent implantation; I: Schematic diagram: The retrieval cord is pulled using a pair of forceps; J: Endoscopy image: The retrieval cord is pulled using a pair of forceps; K: Schematic diagram: The retrievable puncture anchor is easily removed; L: Endoscopy image: The retrievable puncture anchor is easily removed.

Figure 3 Endoscopic imaging of stent placement and anastomoses. A and B: Endoscopic imaging shows the well-reflected proximal flange of the stent immediately after deployment in the initial session; C: The stents were still in the same position 4 wk later and no traumatic changes were observed; D: A standard gastroscope was easily advanced through the anastomosis to observe the afferent and efferent bowel loops.

Figure 4 Autopsy and histological findings. A-C: Necropsy and histological evidence shows complete adhesion between the bowel and the stomach wall (20 ×).