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Why are EUS-guided gastrojejunostomy (EUS-GJ) and EUS-guided gallbladder drainage (EUS-GBD) among the most technically demanding procedures in therapeutic EUS?
Despite technical success rates of 96.9%, EUS-guided gastrojejunostomy (EUS-GJ) requires precise tissue apposition and controlled lumen-apposing metal stent (LAMS) deployment throughout the procedure. A recent meta-analysis reported an overall adverse event rate of 13.0%, including 4.6% LAMS maldeployment, demonstrating the importance of maintaining stable tissue alignment during these critical procedural steps.¹
What is endoscopic organ anchoring in therapeutic EUS?
The KOEDA™ Endoscopic Anchoring System is a novel and unique technique in which an anchor is delivered endoscopically to temporarily approximate and stabilize target tissues during selected EUS-guided interventions. Deployable anchoring flaps temporarily bring the target tissues together and maintain stable tissue apposition during the critical steps of the procedure, complementing the function of lumen-apposing metal stents (LAMS).
Where Clinical Insight Meets Advanced Engineering
From Clinical Challenge to Innovation
For more than 20 years, Toru Okuzono, MD, PhD, Director of Gastrointestinal Medicine at Sendai Kosei Hospital, Sendai, Japan, has dedicated his career to advancing therapeutic endoscopy. Throughout the evolution of endoscopic ultrasound (EUS), he has witnessed the field transform from a diagnostic technique into an advanced therapeutic platform.
The introduction of lumen-apposing metal stents (LAMS) has opened new treatment options for patients requiring minimally invasive procedures such as EUS-guided gastrojejunostomy (EUS-GJ) and EUS-guided gallbladder drainage (EUS-GBD). However, clinical practice has also shown that certain procedural steps remain technically demanding. Achieving stable tissue apposition and maintaining precise control during the critical stages of these interventions can continue to present challenges, even for experienced endoscopists.
Rather than accepting these procedural difficulties as an inherent part of therapeutic EUS, Dr. Okuzono became convinced that a different technical approach was needed.
"I was fascinated by the potential of EUS and LAMS to reduce the burden of surgery for patients. But despite continuous refinement of my own technique, I realized that these limitations were not operator-dependent—but required a technical solution."
This realization marked the beginning of KOEDA.
From Insight to a New Technical Principle
Instead of asking physicians to overcome procedural challenges through greater manual skill, Dr. Okuzono envisioned a dedicated endoscopic anchoring system to ensure precise organ fixation.
Combining clinical insight with advanced engineering, the project utilized nitinol—leveraging its unique shape-memory characteristics and elasticity—to engineer a mechanism small enough for delivery through a standard 19-gauge EUS needle while providing reliable post-deployment fixation.
"I therefore challenged myself to find a better approach and began working on a way to bring more control and precision into organ fixation in these procedures."
The resulting KOEDA™️ Endoscopic Anchor System is designed to support controlled organ fixation during select EUS-guided interventions.
Multidisciplinary Collaboration and Scientific Exchange
Transforming this concept into a medical device required cross-functional expertise. Dr. Okuzono assembled a team of specialists spanning engineering, product development, regulatory affairs, and commercialization.
Furthermore, the system has been continuously refined through rigorous dialogue, critical feedback, and hands-on testing with leading endoscopists across Japan and Europe.
"I was fortunate to find outstanding partners who helped me turn the idea of an endoscopic organ anchoring into reality."
The KOEDA system has been presented at leading scientific meetings, including Digestive Disease Week (DDW), ESGE Days and the Japan Gastroenterological Endoscopy Society (JGES). These meetings provide valuable opportunities to exchange experience with physicians working at the forefront of interventional endoscopy.
Reference
- Giri S, et al. Adverse events with endoscopic ultrasound-guided gastroenterostomy for gastric outlet obstruction: A systematic review and meta-analysis. United European Gastroenterol J. 2024;12(7):879–890. doi:10.1002/ueg2.12576.