A novel safe approach to the peritoneal cavity for per-oral transgastric endoscopic procedures.
BACKGROUND
We have previously reported the feasibility and safety of per-oral transgastric endoscopic procedures in a porcine model.


OBJECTIVE
Our purpose was to evaluate the safety and feasibility of a PEG-like approach to the peritoneal cavity.


METHODS
Acute experiments on 50-kg pigs under general anesthesia.


METHODS
After per-oral intubation, the endoscope was positioned into the body of the stomach, the anterior abdominal wall was transilluminated and punctured with a needle, and a guidewire was inserted into the stomach through the needle. The guidewire was grasped with endoscopic forceps and pulled through the biopsy channel of the endoscope. A sphincterotome was inserted into the gastric wall over the guidewire. Gastric incision was performed and the endoscope was advanced into the peritoneal cavity. The peritoneal cavity was insufflated and endoscopic peritoneoscopy was performed. Then the animal was euthanized and necropsy was performed.


METHODS
Safety of transgastric entrance to peritoneal cavity.


RESULTS
The PEG-like approach was used in 12 pigs. The average procedure time was 11.4 +/- 3.7 minutes. There was only 1 complication related to the access: bleeding from the gastric wall incision was documented when a pure cut (without coagulation) current was used for incision of the gastric wall. There were no complications in the other 11 pigs. The necropsy did not reveal any damage to organs adjacent to the stomach.


CONCLUSIONS
Gastric wall incision is located on anterior gastric wall.


CONCLUSIONS
The PEG-like transgastric approach to the peritoneal cavity appears technically simple and safe.
Kantsevoy
Sergey V
SV
Division of Gastroenterology, Johns Hopkins Hospital, 1550 Orleans Street, Baltimore, MD 21231, USA.
Jagannath
Sanjay B
SB
Niiyama
Hideaki
H
Isakovich
Nina V
NV
Chung
Sydney S C
SS
Cotton
Peter B
PB
Gostout
Christopher J
CJ
Hawes
Robert H
RH
Pasricha
Pankaj J
PJ
Kalloo
Anthony N
AN
D000818:Animals; D004867:Equipment Design; D005240:Feasibility Studies; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods* / Q000662:veterinary; D009055:Mouth; D010529:Peritoneal Cavity / Q000601:surgery*; D013270:Stomach / Q000601:surgery*; D013552:Swine