title: Acute inflammatory response to transgastric natural orifice transluminal endoscopic surgery peritoneoscopy: an experimental study in swine.
abstract: OBJECTIVE
  To investigate the impact of transgastric peritoneal access on plasma biomarkers of acute inflammatory response in comparison to laparoscopy.
  
  
  METHODS
  This was a prospective and comparative study in a porcine model. Transgastric peritoneal access performed by natural orifice transluminal endoscopic surgery was compared with laparoscopy. Laparotomy and sham groups were used as positive and negative controls, respectively. Thirty-four pigs were assigned to receive transgastric natural orifice transluminal endoscopic surgery (n = 12), laparoscopy (n = 8), laparotomy (n = 8) or a sham procedure involving only anesthesia (n = 6). In the natural orifice transluminal endoscopic surgery group, peritoneoscopy was performed with a gastroscope via transgastric access. Blood samples were collected at baseline and 1, 3, 6, 9 and 24 h after the surgical procedure for measurement of interleukins 1β, 6 and 10 and tumor necrosis factor-α. A complete blood count was performed, and C-reactive protein levels were measured at baseline and at 24 h.
  
  
  RESULTS
  All surgical and endoscopic procedures were performed without major complications. Peritoneal cavity inventory showed no signs of peritonitis in any animal. Interleukin 1β, interleukin 10 and tumor necrosis factor-α levels were below the threshold of detection. The mean level of interleukin 6 was statistically significantly higher in the laparotomy group than in the other groups (p<0.05), with no significant differences among the sham, laparoscopy and natural orifice transluminal endoscopic surgery groups (p>0.05). C-reactive protein analysis indicated significant increases in all groups, with no differences among the groups. Complete blood count analysis showed no differences among the groups.
  
  
  CONCLUSIONS
  Based on the observed interleukin 6 patterns, the systemic inflammatory response resulting from transgastric peritoneal access by natural orifice transluminal endoscopic surgery is similar in intensity to the response that occurs after laparoscopy.
authors.affiliation: Gastroenterology Division, São Paulo Federal University (UNIFESP), São PauloSP, Brazil.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Rezende
authors.forename: Edna Frasson de Souza
authors.initials: EF
authors.lastname: Montero
authors.forename: Reinaldo
authors.initials: R
authors.lastname: Salomão
authors.forename: Milena
authors.initials: M
authors.lastname: Brunialti
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Rodrigues
authors.forename: Gustavo
authors.initials: G
authors.lastname: Gomes
authors.forename: Alice Della
authors.initials: AD
authors.lastname: Libera
authors.forename: Angelo
authors.initials: A
authors.lastname: Ferrari
authors.forename: Ermelindo Della
authors.initials: ED
authors.lastname: Libera
mesh_terms: D000818:Animals; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D016207:Cytokines / Q000097:blood; D004195:Disease Models, Animal; D004797:Enzyme-Linked Immunosorbent Assay; D005773:Gastroscopy / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D061646:Operative Time; D010529:Peritoneal Cavity / Q000601:surgery; D010538:Peritonitis / Q000209:etiology; D011446:Prospective Studies; D015203:Reproducibility of Results; D013552:Swine; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology*; D013997:Time Factors
chemical_list: D015415:Biomarkers; D016207:Cytokines; D002097:C-Reactive Protein