Endoscopic transluminal insertion of a peritoneal dialysis catheter.
BACKGROUND
At present there are various more or less invasive surgical and laparoscopic ways to place a catheter suitable for peritoneal dialysis (PD); however, once the catheter is in place, there is no possibility to inspect the peritoneal cavity without de novo laparotomy or laparoscopy.


METHODS
To establish a minimally invasive technique and allowing for maximal options, we used a PD catheter with an extra large inside diameter of 3.5 mm. Because of the enlarged inner diameter of 3.5 mm (compared to 2.6 mm in standard Tenckhoff catheters), this device can be passed by a very thin video-endoscope with an external diameter of 2.8 mm. Using a stepwise approach, we applied this device in placing PD catheters in 2 patients. The procedure could be done without complications. Both patients were doing well 4 and 6 months later, respectively, without any PD-related complications. Intraperitoneal view by the endoscope was limited; an attempt to obtain a peritoneal biopsy failed.


CONCLUSIONS
If the drawbacks of this method can be overcome it will have a wide spectrum of applications (i.e., inspection of the peritoneal cavity and obtaining peritoneal biopsies at any time during PD treatment). In this way it can be used scientifically and clinically when a problem of flow or ultrafiltration occurs or when encapsulating sclerosing peritonitis is suspected.
Mettang
Thomas
T
Department of Nephrology, Deutsche Klinik für Diagnostik, Wiesbaden, Germany. t_mettang@t-online.de
Krumme
Bernd
B
Wilhelm
Arne
A
Duschka
Lothar
L
D002404:Catheterization / Q000379:methods*; D006801:Humans; D020706:Laparoscopes; D010535:Laparoscopy; D010530:Peritoneal Dialysis / Q000295:instrumentation* / Q000379:methods*