An intestinal occlusion device for prevention of small bowel distention during transgastric natural orifice transluminal endoscopic surgery.
OBJECTIVE
Bowel distention from luminal gas insufflation reduces the peritoneal operative domain during natural orifice transluminal endoscopic surgery (NOTES) procedures, increases the risk for iatrogenic injury, and leads to postoperative patient discomfort.


METHODS
A prototype duodenal occlusion device was placed in the duodenum before NOTES in 28 female pigs. The occlusion balloon was inflated and left in place during the procedure, and small bowel distension was subjectively graded. One animal had no balloon occlusion, and 4 animals had a noncompliant balloon placed.


RESULTS
The balloon maintained its position and duodenal occlusion in 22 animals (79%) in which the bowel distention was rated as none (15), minor (4), moderate (3), or severe (0). The intestinal occlusion catheter failed in 6 animals (21%) because of balloon leak (5) or back-migration into the stomach (1), with distention rated as severe in 5 of these 6 cases.


CONCLUSIONS
The intestinal occlusion catheter that maintains duodenal occlusion significantly improves the intraabdominal working domain with enhanced visualization of the viscera during the NOTES procedure while requiring minimal time and expense.
Division of Minimally Invasive Surgery, Penn State Hershey Medical Center, Hershey, PA, USA.
Jonathan M
JM
Tomasko
Abraham
A
Mathew
Matthew T
MT
Moyer
Randy S
RS
Haluck
Eric M
EM
Pauli
D000818:Animals; D021721:Balloon Occlusion / Q000295:instrumentation*; D004378:Duodenal Diseases / Q000517:prevention & control; D004867:Equipment Design; D005260:Female; D007327:Insufflation; D007416:Intestinal Perforation / Q000517:prevention & control*; D057605:Natural Orifice Endoscopic Surgery / Q000009:adverse effects / Q000295:instrumentation*; D013552:Swine