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

Background Localization of the proximal jejunum is important for creation of a gastrojejunal anastomosis to palliate gastric outlet obstruction or for treatment of obesity with gastric bypass. We report the use of an endoscopic transilluminator (ET) to facilitate identification of the proximal jejunum during transgastric endoscopic gastrojejunostomy. Methods 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. We performed experiments in a live porcine model. Under general anesthesia with endotracheal intubation, a colonoscope was advanced to the proximal jejunum. A 3500-mm long, 3.5-mm plastic tube 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 The colonoscope was withdrawn, leaving the tube in place.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 a gastrojejunal anastomosis was made, using a previously reported endoscopic technique. Results Eleven pigs (average weight, 55 kg) had ET placement, which was performed easily to the proximal small bowel. In all pigs, the proximal jejunum was successfully localized by either direct visualization of the transilluminated loop alone or with the aid of fluoroscopy. The ET tip was usually located about 50 to 70 cm distal to the ligament of Treitz. There were no complications related to the use of the ET. Conclusion The ET is a safe instrument and can be used to identify the proximal jejunum, facilitating endoscopic gastrojejunostomy.