title: Ultrathin Endoscopy-Guided Pericardiocentesis: A Pilot Study in a Swine Model.
abstract: BACKGROUND
  Pericardiocentesis under echocardiography guidance is a common procedure, but still poses a risk of injury to surrounding tissues. Nowadays, pericardiocentesis is being performed in patients with normal pericardium, for epicardial ablation or atrial appendage exclusion. Access to the normal pericardial space with the conventional needle procedure is very difficult. Thus, development of a novel method enabling safer pericardiocentesis is necessary. The present study aimed to assess the feasibility of using an originally developed ultrathin endoscopy-guided pericardiocentesis device in a swine model.
  
  
  RESULTS
  We developed a novel ultrathin endoscopy-guided pericardiocentesis device. The device comprised a 1.2 mm ultrathin endoscope, a 20 G needle, and a grasping forceps. Pericardiocentesis was conducted as follows. A 12 Fr introducer sheath was inserted between the pericardium and the diaphragm under fluoroscopy. The pericardium was grasped with the originally developed forceps under endoscopy guidance to create a space in the pericardial sac. The 20 G needle was then inserted and a coiled-tip guidewire was placed into the pericardial sac. Five independent operators performed pericardiocentesis twice using this technique in a healthy pig with a body weight of approximately 25 kg. Procedural success rate and procedure time were assessed as the primary endpoints. The procedural success rate was 100% in all operators. The average procedure time was 65 ± 40 seconds (median, 46 seconds; interquartile range, 40-85 seconds). No procedure-related complications were noted.
  
  
  CONCLUSIONS
  The study results indicate that ultrathin endoscopy-guided pericardiocentesis for normal pericardial space is feasible and safe.
authors.forename: Kenji
authors.initials: K
authors.lastname: Nakatsuma
authors.forename: Erika
authors.initials: E
authors.lastname: Yamamoto
authors.forename: Shin
authors.initials: S
authors.lastname: Watanabe
authors.forename: Bingyuan
authors.initials: B
authors.lastname: Bao
authors.forename: Hiroki
authors.initials: H
authors.lastname: Watanabe
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Kawase
authors.forename: Satoshi
authors.initials: S
authors.lastname: Shizuta
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kimura
authors.affiliation: Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507 Japan. naritatu@kuhp.kyoto-u.ac.jp.
authors.forename: Naritatsu
authors.initials: N
authors.lastname: Saito
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D019723:Endoscopes; D004724:Endoscopy / Q000379:methods*; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D008904:Miniaturization; D010490:Pericardial Effusion / Q000175:diagnosis / Q000601:surgery*; D020519:Pericardiocentesis / Q000295:instrumentation*; D013552:Swine