Gastric emptying is delayed in transgastric NOTES: a randomized study in swine.
OBJECTIVE
The aim of this study was to evaluate the restoration of gastrointestinal motility after NOTES using capsule endoscopy (CE).


METHODS
Twenty adult Yorkshire pigs were randomly assigned to four groups: transgastric NOTES (gNOTES), transrectal NOTES (rNOTES), transvaginal NOTES (vNOTES), and laparoscopy (LAP). At the end of a 30-min peritoneoscopy with identification of seven predetermined organs, an array of eight receivers and the recorder were attached to the abdominal wall. The CE was delivered into the antrum with the help of an endoscope and a polypectomy snare. Animals were kept alive for 14 d.


RESULTS
Median time for surgery was longer in gNOTES (56 min, range 47-63) and vNOTES (54 min, range 44-79) than in LAP (32 min, range 32-33; P < 0.05 and P < 0.01) and in rNOTES (45.5 min, range 33-56) (P = ns). This increase was related to a larger incision and longer closure times. Images from the CE were successfully retrieved in 19 cases. The CE was retained in the stomach in all animals in gNOTES (459 min; range 360-600), but only in one animal in rNOTES and vNOTES and in none in the LAP group. Failure of passage of the CE beyond the stomach was associated with gNOTES and longer closure of the incision. Animals in the gNOTES group gained less weight than the others and this change was statistical significant when compared with vNOTES animals (1.7 kg, range -1.98 to 4.5 versus 8.4 kg, range 5.8 to 11.45; P < 0.01).


CONCLUSIONS
Gastric emptying is delayed after gNOTES peritoneoscopy compared with rNOTES, vNOTES, and LAP and this effect is associated with less weight gain.
Department of Gastroenterology, Hospital Clinic, University of Barcelona, Barcelona, Spain.
Henry
H
Córdova
Carlos
C
Guarner-Argente
Graciela
G
Martínez-Pallí
Ricard
R
Navarro
Antonio
A
Rodríguez-D'Jesús
Cristina
C
Rodríguez de Miguel
Mireia
M
Beltrán
M Àngels
MÀ
Martínez-Zamora
Jaume
J
Comas
Antonio M
AM
Lacy
Christopher C
CC
Thompson
Gloria
G
Fernández-Esparrach
D000818:Animals; D053704:Capsule Endoscopy; D005260:Female; D005746:Gastric Emptying; D010535:Laparoscopy; D057605:Natural Orifice Endoscopic Surgery / Q000009:adverse effects*; D011897:Random Allocation; D013270:Stomach / Q000601:surgery; D013552:Swine