Transgastric endoscopic peritoneoscopy does not require decontamination of the stomach in humans.
BACKGROUND
Natural orifice translumenal endoscopic surgery (NOTES) is a rapidly evolving field that provides endoscopic access to the peritoneum via a natural orifice. One important requirement of this technique is the need to minimize the risk of clinically significant peritoneal contamination. We report the bacterial load and contamination of the peritoneal cavity in ten patients who underwent diagnostic transgastric endoscopic peritoneoscopy.


METHODS
Patients participating in this trial were scheduled to undergo diagnostic laparoscopy for evaluation of presumed pancreatic cancer. Findings at diagnostic laparoscopy were compared with those of diagnostic transgastric endoscopic peritoneoscopy, using an orally placed gastroscope, blinding the endoscopist to the laparoscopic findings. We performed no gastric decontamination. Diagnostic findings, operative times, and clinical course were recorded. Gastroscope and peritoneal fluid aspirates were obtained prior to and after the gastrotomy. Each sample was sent for bacterial colony counts, culture, and identification of species.


RESULTS
Ten patients, with an average age of 63.7 years, have completed the protocol. All patients underwent diagnostic laparoscopy followed by successful transgastric access and diagnostic peritoneoscopy. The average time for laparoscopy was 7.2 min, compared with 18 min for transgastric instrumentation. Bacterial sampling was obtained in all ten patients. The average number of colony-forming units (CFU) in the gastroscope aspirate was 132.1 CFU/ml, peritoneal aspirates prior to creation of a gastrotomy showed 160.4 CFU/ml, and peritoneal sampling after gastrotomy had an average of 642.1 CFU/ml. There was no contamination of the peritoneal cavity with species isolated from the gastroscope aspirate. No infectious complications or leaks were noted at 30-day follow-up.


CONCLUSIONS
There was no clinically significant contamination of the peritoneal cavity from the gastroscope after transgastric endoscopic instrumentation in humans. Transgastric instrumentation does contaminate the abdominal cavity but, the pathogens do not mount a clinically significant response in terms of either the species or the bacterial load.
Division of General & Gastrointestinal Surgery, The Ohio State University School of Medicine and Public Health, Columbus, OH, USA. raaja.narula@osumc.edu
Vimal K
VK
Narula
Lynn C
LC
Happel
Kevin
K
Volt
Simon
S
Bergman
Jason C
JC
Roland
Rebecca
R
Dettorre
David B
DB
Renton
Kevin M
KM
Reavis
Bradley J
BJ
Needleman
Dean J
DJ
Mikami
E Christopher
EC
Ellison
W Scott
WS
Melvin
Jeffrey W
JW
Hazey
D001424:Bacterial Infections / Q000382:microbiology / Q000517:prevention & control; D015169:Colony Count, Microbial; D020699:Gastroscopes; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000175:diagnosis*; D010529:Peritoneal Cavity / Q000382:microbiology; D010533:Peritoneal Lavage / Q000379:methods; D010538:Peritonitis / Q000382:microbiology / Q000517:prevention & control; D011379:Prognosis