title: A novel safe approach to the peritoneal cavity for per-oral transgastric endoscopic procedures.
abstract: 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.
authors.affiliation: Division of Gastroenterology, Johns Hopkins Hospital, 1550 Orleans Street, Baltimore, MD 21231, USA.
authors.forename: Sergey V
authors.initials: SV
authors.lastname: Kantsevoy
authors.forename: Sanjay B
authors.initials: SB
authors.lastname: Jagannath
authors.forename: Hideaki
authors.initials: H
authors.lastname: Niiyama
authors.forename: Nina V
authors.initials: NV
authors.lastname: Isakovich
authors.forename: Sydney S C
authors.initials: SS
authors.lastname: Chung
authors.forename: Peter B
authors.initials: PB
authors.lastname: Cotton
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Gostout
authors.forename: Robert H
authors.initials: RH
authors.lastname: Hawes
authors.forename: Pankaj J
authors.initials: PJ
authors.lastname: Pasricha
authors.forename: Anthony N
authors.initials: AN
authors.lastname: Kalloo
mesh_terms: 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