title: Transgastric endoscopic peritoneoscopy does not lead to increased risk of infectious complications.
abstract: BACKGROUND
  It remains important to determine the risk of bacterial contamination and infectious complications of the peritoneal cavity as it pertains to transgastric natural orifice translumenal endoscopic surgery (NOTES) procedures. The infectious implications of such procedures have been quantified in animal models. This report discusses the infectious risks of transgastric endoscopic peritoneoscopy (TEP) in a human clinical trial.
  
  
  METHODS
  Under institutional review board approval, 40 patients scheduled for laparoscopic Roux-en-Y gastric bypass (LRYGB) participated in this study. The TEP procedure was performed without preoperative gastric decontamination and without laparoscopic guidance. Preoperative intravenous antibiotics were given. Saline aspirates were taken from the gastric lumen before endoscopic gastrotomy creation and from the peritoneal cavity after transgastric access. Samples were sent for culture, identification, and bacterial counts. Subgroup analysis was performed on patients taking proton pump inhibitors (PPIs). These data were compared with data for "sterile" peritoneal aspirates from a historical cohort of 50 patients undergoing LRYGB.
  
  
  RESULTS
  The median number of bacteria isolated from the gastric aspirates was 980 colony-forming units (CFU)/ml (n=40). The median number of bacteria isolated from the peritoneal aspirates was 323 CFU/ml. Cross-contamination from the stomach to the peritoneal cavity was documented in eight cases. No abscesses or anastomotic leaks were recorded. One port-site infection occurred. Subgroup analysis of 15 patients receiving PPIs showed elevated bacterial counts in gastric aspirates and the post-TEP peritoneal samples compared with patients not receiving PPIs (n=25). This subgroup on PPI's did not have an increase in infectious complications.
  
  
  CONCLUSIONS
  Contamination of the peritoneal cavity does occur with TEP, but this does not lead to an increased risk of infectious complications. Similarly, patients receiving PPIs have an increased gastric bacterial load and increased contamination after TEP but not an increased risk of infectious complications.
authors.affiliation: Center for Minimally Invasive Surgery, The Ohio State University School of Medicine and Public Health, 410 West 10th Avenue, Columbus, OH 43210-1228, USA.
authors.forename: Vanchad C
authors.initials: VC
authors.lastname: Memark
authors.forename: Joel B
authors.initials: JB
authors.lastname: Anderson
authors.forename: Peter N
authors.initials: PN
authors.lastname: Nau
authors.forename: Nilay
authors.initials: N
authors.lastname: Shah
authors.forename: Bradley J
authors.initials: BJ
authors.lastname: Needleman
authors.forename: Dean J
authors.initials: DJ
authors.lastname: Mikami
authors.forename: William S
authors.initials: WS
authors.lastname: Melvin
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Hazey
mesh_terms: D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000401:mortality / Q000517:prevention & control*; D058491:Bacterial Load; D005260:Female; D015390:Gastric Bypass; D006801:Humans; D008297:Male; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery; D010529:Peritoneal Cavity / Q000382:microbiology; D010538:Peritonitis / Q000382:microbiology / Q000517:prevention & control*; D011183:Postoperative Complications / Q000382:microbiology / Q000517:prevention & control*; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D018709:Statistics, Nonparametric
chemical_list: D054328:Proton Pump Inhibitors