Creation of esophagojejunostomy with OrVil device

(A) The OrVil anvil is passed transorally to the stapled esophageal stump trailing a specially designed nasogastric tube. A small incision is made in the middle of the esophageal staple line to allow the nasogastric tube to pass. Once the tube is pulled into the abdominal cavity, it is disconnected from the anvil by cutting the connecting thread.
(B) An EEA stapler is advanced into the lumen of the loop of jejunum to be anastomosed to the esophagus. The spike, which punctures the jejunal wall, is connected with the anvil.
(C) The EEA stapler is closed and fired, creating a circular stapled esophagojejunal anastomosis.
(D) The EEA stapler is removed from the jejunum. The open end is closed with a linear endoscopic stapler.
(E) Detailed view of an EEA stapled esophagojejunostomy with the OrVil device.