Increased postprandial glucagon-like peptide-1 (GLP-1) production after endoscopic gastrointestinal bypass using the Cousin lumen-apposing stent in a porcine model

Endoscopy. 2018 Jan;50(1):14-21. doi: 10.1055/s-0043-120439. Epub 2017 Dec 1.


BACKGROUND AND STUDY AIMS : Endoscopic techniques have demonstrated their effectiveness in metabolic surgery, notably through a gastrointestinal (GI) liner, with a less invasive approach than conventional surgery. Our study evaluates the safety and efficacy of endoscopic GI anastomosis (EGIA) using a lumen-apposing stent to secure the anastomosis. MATERIALS AND METHODS : EGIA was performed using the transgastric approach with a two-channel endoscope with a novel stent (Cousin Biotech). First, a safety study with a follow-up of 12 months was performed on five piglets. Then, metabolic changes were investigated in a minipig model (n = 10) before and after EGIA or open GIA (OGIA).

Results: EGIA was technically successful with no complications observed during clinical monitoring. Endoscopic and postmortem examinations during the second part of study showed a secure anastomosis between the stomach and the intestinal limb in all except one minipig. Both minipigs subjected to EGIA and those in the control group (OGIA) exhibited increased postprandial glucagon-like peptide-1 (GLP-1) production (incretin secretion) and impaired D-xylose absorption (malabsorption effect). CONCLUSION : Performing EGIA with this dedicated stent appears safe, technically feasible, durable, and reproducible in providing a simple and effective endoscopic GI bypass capable of ensuring metabolic effect.

MeSH terms

  • Anastomosis, Surgical / instrumentation
  • Anastomosis, Surgical / methods
  • Animals
  • Blood Glucose
  • Endoscopy, Gastrointestinal / instrumentation*
  • Endoscopy, Gastrointestinal / methods
  • Feasibility Studies
  • Female
  • Glucagon-Like Peptide 1 / blood*
  • Intestinal Absorption
  • Jejunum / surgery*
  • Male
  • Postprandial Period
  • Self Expandable Metallic Stents*
  • Stomach / surgery*
  • Swine
  • Xylose / metabolism


  • Blood Glucose
  • Glucagon-Like Peptide 1
  • Xylose