Endoscopic Ultrasound-Directed Transgastric Endoscopic Retrograde Cholangiopancreatography in a Patient with Gastric Bypass. Report of the First Local Case

We describe the first case in our environment of endoscopic ultrasound (EUS)-assisted transgastric endoscopic retrograde cholangiopancreatography in a patient with gastric bypass surgery. The procedure was performed with a side-viewing duodenoscope through a jejunogastrostomy using apposing stents, placed with EUS assistance, and a standard technique and instruments.

Se describe el primer caso en nuestro medio de colangiopancreatografía retrógrada endoscópica transgástrica asistida por endosonografía en una paciente con cirugía de baipás gástrico. El procedimiento se realizó con duodenoscopio de visión lateral a través de una yeyunogastrostomía por stent de aposición, emplazado con asistencia endosonográfica y con una técnica e instrumental estándar.

Feasibility and safety of endoscopic trans-gastric cholecystolithotomy combined with endoscopic retrograde cholangiopancreatography for cholecystolithiasis and choledocholithiasis (with video) / 中华消化内镜杂志

To investigate the feasibility and safety of endoscopic trans-gastric cholecystolithotomy(ETGC) combined with endoscopic retrograde cholangiopancreatography (ERCP) for cholecystolithiasis and choledocholithiasis. Data of patients with cholecystolithiasis and choledocholithiasis who underwent ETGC after ERCP in Zhongshan Hospital Affiliated to Fudan University from November 2018 to April 2019 were analyzed. Six patients with cholecystolithiasis and choledocholithiasis, 4 males and 2 females, were included in this study.The interval between ERCP and ETGC ranged from 1 to 77 days (median 5 days). All the 6 patients successfully completed ETGC after ERCP, with a surgical success rate of 100%. All the patients had multiple cholecystolithiasis and one patient was complicated with gallbladder polyps.The ETGC operation time was 22-100 min (median 65 min), and the length of hospital stay was 3-9 d (median 6.5 d). Two patients had dull pain in the upper abdomen and increased body temperature after surgery. Abdominal ultrasound in one patient suggested local effusion in the right upper abdomen.Both patients improved after conservative treatment.None of the patients had cholecystitis and cholangitis related symptoms such as right upper abdominal pain or fever during postoperative follow-up, and the follow-up rate was 100%with median follow-up time of 18 month.All the 6 patients underwent abdominal ultrasound examination after surgery. No recurrence occurred in 5 patients. One of the patients showed cholesterol crystals in the gallbladder wall and bile mud deposition.ETGC combined with ERCP is safe and feasible for cholecystolithiasis and choledocholithiasis.

Spectrum of imaging findings in trans-gastric migration of accidently ingested metallic foreign bodies

Background: An accidently ingested foreign body may get lodged within the lumen of gastrointestinal tract, pass uneventfully with feces or may migrate extraluminally into the surrounding tissues in which case it may lead to suppurative or vascular complications. The aim of the endeavor was to study the spectrum of imaging findings in patients with accidental ingestion of foreign bodies with trans-gastric migration of metallic foreign bodies.Methods: Total 33 patients with history of accidental ingestion of foreign bodies were subjected to preliminary radiograph of neck, chest and abdomen followed by upper gastrointestinal endoscopy. Failure to retrieve/ localize foreign body endoscopically from upper gastrointestinal tract with check radiograph reiterating the presence of foreign body in upper abdomen were subjected to computed tomography of abdomen.Results: A total of 33 patients comprising of 27 females and 6 males with mean age of 23.76 years with history of foreign body ingestion were studied. Ingested foreign bodies were lodged in pharynx (n=7), esophagus (n=3), stomach (n=13) or duodenum (n=3). In 7 patients in whom endoscopy failed to locate and/or retrieve foreign body, computed tomography confirmed the presence of trans-gastrically migrated foreign body in the surrounding structures. The location of migrated foreign bodies was in lesser sac (n = 2), greater omentum (n = 3), lesser omentum (n = 1) and transmural (n = 1). Two patients had evidence of collection formation around the migrated foreign bodies.Conclusions: Sharp or pointed metallic foreign bodies may migrate trans-luminally with various implications. Though radiography is the preliminary workhorse for the confirmation of ingested foreign bodies, computed tomography owing to its volumetric data acquisition helps in exact localization of migrated foreign bodies and should precede any therapeutic intervention for retrieval of migrated foreign bodies.

Endoscopic Ultrasound-Guided Transgastric Drainage of an Intra-Abdominal Abscess following Gastrectomy

Endoscopic ultrasound (EUS)-guided transgastric drainage has been performed as a less invasive procedure for pancreatic fistulas and intra-abdominal abscesses occurring after surgery in recent years. However, there are no reports of EUS-guided transgastric drainage of intra-abdominal abscesses following gastrectomy. This case report describes 2 patients who developed an intra-abdominal abscess following gastrectomy and underwent EUS-guided transgastric drainage. Both patients underwent laparoscopy-assisted distal gastrectomy with Billroth-I reconstruction for gastric cancer. The intra-abdominal abscesses were caused by postoperative pancreatic fistula that developed following gastrectomy. One patient underwent naso-cystic drainage and the other underwent only a needle puncture of the abscess cavity. EUS-guided drainage was performed safely and effectively, although 1 patient developed gastroduodenal anastomotic leakage related to this procedure. In summary, EUS-guided transgastric drainage is safe and technically feasible even in post-gastrectomy patients. However, it is necessary to be careful if this procedure is performed in the early period following gastrectomy.

A preliminary study of endoscopic trans-gastric gallbladder-preserving cholecystolithotomy for cholecystolithiasis (with video) / 中华消化内镜杂志

Objective@#To investigate the feasibility and safety of endoscopic trans-gastric gallbladder-preserving cholecystolithotomy (ETGC) for gallstones.@*Methods@#The clinical data of 84 cholecystolithiasis patients, who received ETGC at Endoscopic Center of Zhongshan Hospital from March 2017 to May 2019 were analyzed retrospectively. The operation completion rate, operation time, complications and recurrence of calculus were summarized.@*Results@#In the 84 cases of cholecystolithiasis, there were 19 cases (22.6%) of single stone, 53 cases (63.1%) of multiple stones, and 12 cases (14.3%) of gallstones with gallbladder polyps. A total of 82 patients (97.6%) successfully completed ETGC with median operation time of 88 min. Ten patients (12.2%) suffered from abdominal pain after operation, of which 6 patients relieved after conservative treatments. The other 4 cases, including 2 cases of hemoperitoneum, 1 case of biliary fistula, and 1 case of choledocholithiasis with obstructive jaundice, were recovered after corresponding interventions. As of June 14, 2019, 5 cases were lost to follow-up (follow-up rate was 93.9%, 77/82). Residual stones were found in 2 cases (2.6%, 2/77). Stone recurrence was discovered in 4 cases (5.2%, 4/7), and 2 cases (2.6%, 2/77) had cholesterol crystallization in gallbladder.@*Conclusion@#ETGC is minimally invasive, feasible and safe in treatment of cholecystolithiasis, and can retain the function of gallbladder. However, how to completely remove the stones and avoid residue by ETGC still needs further exploration, and its long-term efficacy still needs further observation.

A preliminary study of endoscopic trans-gastric gallbladder-preserving cholecystolithotomy for cholecystolithiasis ( with video) / 中华消化内镜杂志

Objective To investigate the feasibility and safety of endoscopic trans-gastric gallbladder-preserving cholecystolithotomy (ETGC) for gallstones. Methods The clinical data of 84 cholecystolithiasis patients, who received ETGC at Endoscopic Center of Zhongshan Hospital from March 2017 to May 2019 were analyzed retrospectively. The operation completion rate, operation time, complications and recurrence of calculus were summarized. Results In the 84 cases of cholecystolithiasis, there were 19 cases ( 22. 6％) of single stone, 53 cases ( 63. 1％) of multiple stones, and 12 cases ( 14. 3％) of gallstones with gallbladder polyps. A total of 82 patients ( 97. 6％) successfully completed ETGC with median operation time of 88 min. Ten patients ( 12. 2％) suffered from abdominal pain after operation, of which 6 patients relieved after conservative treatments. The other 4 cases, including 2 cases of hemoperitoneum, 1 case of biliary fistula, and 1 case of choledocholithiasis with obstructive jaundice, were recovered after corresponding interventions. As of June 14, 2019, 5 cases were lost to follow-up ( follow-up rate was 93. 9％, 77/82 ) . Residual stones were found in 2 cases ( 2. 6％, 2/77 ) . Stone recurrence was discovered in 4 cases ( 5. 2％, 4/7 ) , and 2 cases ( 2. 6％, 2/77 ) had cholesterol crystallization in gallbladder. Conclusion ETGC is minimally invasive, feasible and safe in treatment of cholecystolithiasis, and can retain the function of gallbladder. However, how to completely remove the stones and avoid residue by ETGC still needs further exploration, and its long-term efficacy still needs further observation.

Colangiopancreatografía asistida por laparoscopia en bypass gástrico y fistulotomía pre-corte por cálculo impactado en papila / Colangiopancreatography Assisted by Laparoscopy in Gastric Bypass and Fistulotomy Pre-Cut by Calculation Impacted in Papila

La denominada cirugía bariátrica “Bypass Gástrico” es una de las operaciones bariátricas mayormente efectuadas a nivel mundial y en aumento en años recientes. La exclusión del estómago y duodeno, después del procedimiento, deja con gran dificultad, la ejecución vía oral, de la Colangiopancreatografía endoscópica (CPRE) y el acceso al tracto biliar y pancreático. Debido a la incrementada incidencia de litiasis biliar en pacientes luego del procedimiento “bypass gástrico”, habrá más requerimiento de la Colangiopancreatografía endoscópica. En los últimos años se ha demostrado que los pacientes con bypass gástrico que ameriten evaluar el tracto biliopancreático pueden someterse exitosamente a Colangiopancreatografía endoscópica terapéutica transgástrica asistida por laparoscopia, en forma segura y confiada. Presentamos nuestra paciente con litiasis residual: cálculo impactado en la papila, efectuando la Colangiopancreatografía endoscópica transgástrica asistida por laparoscopia e Fistulotomía con bisturí - aguja por cálculo impactado en la papila, resuelto satisfactoriamente.

The “Gastric Bypass” is one of the most performed bariatric operatio ns worldwide, and in recent years the number of former bypass patients accrues. The gastric bypass excludes the stomach and duodenum, and it makes very difficult, by oral route, the access to the biliopancreatic tract, by means the endoscopic retrograde cholangiopancreatography (ERCP). Due to the increased evidence of gallstones after bariatric operations, the ERCP could be more often required. In recent years, it has been demostrated that gastric bypass patients can be successfully evaluated endoscopically by laparoscopic transgastric ERCP, as a safe and reliable method. We describe a patient with residual billiary impacted stone in the papilla, who underwent laparoscopic transgastric ERCP and a precut “fistulotomy” technique with needle - knife, was highly successful, without add significant morbidity to the procedure.

Endoscopic Ultrasound (EUS)-Directed Transgastric Endoscopic Retrograde Cholangiopancreatography or EUS: Mid-Term Analysis of an Emerging Procedure

BACKGROUND/AIMS: Performing endoscopic retrograde cholangiopancreatography (ERCP) in patients who have undergone Rouxen-Y gastric bypass (RYGB) is challenging. Standard ERCP and enteroscopy-assisted ERCP are associated with limited success rates. Laparoscopy- or laparotomy-assisted ERCP yields improved efficacy rates, but with higher complication rates and costs. We present the first multicenter experience regarding the efficacy and safety of endoscopic ultrasound (EUS)-directed transgastric ERCP (EDGE) or EUS. METHODS: All patients who underwent EDGE at two academic centers were included. Clinical success was defined as successful ERCP and/or EUS through the use of lumen-apposing metal stents (LAMS). Adverse events related to EDGE were separated from ERCP- or EUS-related complications and were defined as bleeding, stent migration, perforation, and infection. RESULTS: Sixteen patients were included in the study. Technical success was 100%. Clinical success was 90% (n=10); five patients were awaiting maturation of the fistula tract prior to ERCP or EUS, and one patient had an aborted ERCP due to perforation. One perforation occurred, which was managed endoscopically. Three patients experienced stent dislodgement; all stents were successfully repositioned or bridged with a second stent. Ten patients (62.5%) had their LAMS removed. The average weight change from LAMS insertion to removal was negative 2.85 kg. CONCLUSIONS: EDGE is an effective, minimally invasive, single-team solution to the difficulties associated with ERCP in patients with RYGB.

Clinical research of transgastric approach transluminal endoscopic surgery in diagnosing unexplained ascites / 重庆医学

Objective To explore the clinical value of transgastric natural orifice transluminal endoscopic surgery(NOTES)in diagnosing unexplained ascites.Methods The clinical data in 12 cases of unexplained ascites diagnosed by adopting transgastric approach NOTES and performed abdominal exploration and peritoneal biopsy in our hospital from November 2015 to July 2016 were retrospectively analyzed.The operative risk and clinical application value were evaluated by statistically analyzing the postoperative complications occurrence and the diagnosis rate of disease.Results The definite diagnosis rate reached 100％ verified by pathology after abdominal exploration and peritoneal biopsy,in which 8 cases(66.7％)were tuberculous peritonitis,2 cases(16.7％)were liver cirrhosis,1 case(8.3％)was peritoneal mesothelioma,1 cases(8.3％)was peritoneal metastatic carcinoma;2 cases appeared abdominal pain after operation,including 1 case of neutrophil ratio increase,symptoms and persistent time of abnormal laboratory indexes did not exceed 24 h,the incidence rate was 8.3％;no complications of abdominal cavity infection,incision bleeding and puncture site fistula occurred.Conclusion The transgastric NOTES for conducting abdominal exploration and peritoneal biopsy in the diagnosis of unexplained ascites has the advantages of small trauma,less complications and rapid postoperative recovery,possesses an important clinical application value.

Hemorragia digestiva por úlcera duodenal pós-bypass gástrico em estômago excluso: abordagem endoscópica transgástrica por laparoscopia / Gastrointestinal bleeding by duodenal ulcer after gastric bypass in excluded stomach: endoscopic transgastric approach by laparoscopy

O Bypass Gástrico é uma das cirurgias bariátricas mais realizadas no Brasil e no mundo. Com o aumento exponencial da utilização desta técnica cirúrgica, complicações a longo prazo podem ocorrer. Nesse contexto, é necessário um bom conhecimento pós-operatório, principalmente em relação à fisiopatologia gastrointestinal destes pacientes. Uma complicação rara, porém, extremamente grave, é a úlcera duodenal sangrante. Uma razão para isto é o difícil acesso ao estômago excluso e ao duodeno através da endoscopia digestiva alta. Este relato demonstra uma úlcera duodenal sangrante em paciente pós-operatório de bypass gástrico laparoscópico.

Gastric bypass in Roux-Y is the most common bariatric surgery in Brazil and the world. With the exponential increase of this surgical technique, complications can occur. In this context, is required a great knowledge postoperatively, especially in relation to gastrointestinal pathophysiology of these patients. A rare complication, however, extremely severe, is a duodenal ulcer bleeding. One account for this is the difficult to access excluded stomach and the duodenum through the endoscopy. This case report shows a duodenal ulcer bleeding in a patient postoperative laparoscopic gastric bypass.

Evaluation of endoscopic ultrasound-guided transgastric or transpapillary drainage in treatment of pancreatic pseudocyst / 中国内镜杂志

Objective To explore the clinical efficacy of endoscopic transgastric or transpapillary drainage in treatment of pancreatic pseudocyst. Methods 100 patients with pancreatic pseudocyst from March 2014 to March 2015, 80 cases were underwent endoscopic ultrasound-guided transgastric and the other 20 cases were underwent transpapillary drainage. The treatment effect and complications were recorded. Results The success rate was 95.00 %, and cysts completely disappeared in 84.00 % of the patients. Among all the patients there are 10 cases occurred intraoperative bleeding, 3 cases occurred stent clogging or migration and 7 cases occurred infection, the overall incidence of complications was 20.00 %. Conclusion Endoscopic transgastric or transpapillary drainage in treatment of pancreatic pseudocysts has better clinical curative effect, and can also reduce the occurrence of complications, which is worth popularizing clinically.

Endoscopic Gallbladder Drainage for Acute Cholecystitis

BACKGROUND/AIMS: Surgery is the mainstay of treatment for cholecystitis. However, gallbladder stenting (GBS) has shown promise in debilitated or high-risk patients. Endoscopic transpapillary GBS and endoscopic ultrasound-guided GBS (EUS-GBS) have been proposed as safe and effective modalities for gallbladder drainage. METHODS: Data from patients with cholecystitis were prospectively collected from August 2004 to May 2013 from two United States academic university hospitals and analyzed retrospectively. The following treatment algorithm was adopted. Endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and cystic duct stenting was initially attempted. If deemed feasible by the endoscopist, EUS-GBS was then pursued. RESULTS: During the study period, 139 patients underwent endoscopic gallbladder drainage. Among these, drainage was performed in 94 and 45 cases for benign and malignant indications, respectively. Successful endoscopic gallbladder drainage was defined as decompression of the gallbladder without incidence of cholecystitis, and was achieved with ERCP and cystic duct stenting in 117 of 128 cases (91%). Successful endoscopic gallbladder drainage was also achieved with EUS-guided gallbladder drainage using transmural stent placement in 11 of 11 cases (100%). Complications occurred in 11 cases (8%). CONCLUSIONS: Endoscopic gallbladder drainage techniques are safe and efficacious methods for gallbladder decompression in non-surgical patients with comorbidities.

Combined transgastricand transvesical approach for porcine partial nephrectomy and application of V-loc suture / 第二军医大学学报

Objective To perform partial nephrectomy via combined transgastric and transvesical approach in porcine and to use V-loc suture for suturing the renal defect, so as to further assess the safety and feasibility of combined transgastric and transvesical approach. Methods Three female pigs were used in this study. The transvesical access was established by incising the anterior wall of the bladder under ureteroscope, and a self-designed Trocar was inserted. Under the guidance of ureteroscopy, the transgastric accesswas established by a needle knife with cautery, and the gastroscope was introduced after balloon dilation. Under the guidance of gastroscope, laparoscopic ultrasonic scalpel was introduced via the bladder Trocar; the kidney artery and veinwere separated, the arteries were blocked and some lower part of renal parenchyma was resected; and the wound was closed by 2-0 V-loc suture which was introduced percutaneously. The specimens were collected from the bladder. Results Six partial nephrectomy procedureswere done in the 3 pigs. The first case was transferred to traditional laparoscopy due to incompleted blocking of the artery, bleeding and loss of vision. The rest 5 cases were successfully completed, with a mean operation time of 174 min(140-220 min), a warm ischemia time of 21 min (17-28 min), and with no significant bleeding. The average size of incised tissue was 1. 5 cm X1. 5 cm. Conclusion Partial nephrectomy via combined transgastric and transvesical approach is extremely difficult, but it can be done by using the V-loc suture and auxiliary needle laparoscopic instrument; however, its clinical prospect still needs further verification.

Betadine solution irrigation of gastrointestinal tract for infection prevention during natural orifice transluminal endoscopic surgery / 中华消化内镜杂志

Objective To evaluate the feasibility and efficacy of betadine solution irrigation of gastrointestinal tract for infection prevention during the procedure of natural orifice transluminal endoscopic surgery(NOTES).Methods Twelve female porcine were divided into control group(n =4)to receive lavage with 500 ml normal saline and experimental group(n =8)to undergo lavage with 500 ml normal saline followed by 200 ml betadine solution.Fluid from gastrointestinal tract(5 ml)were collected before and after lavage,and after NOTES for culture.Endoscopy was performed 24 hours after NOTES to observe possible existence of inflammation,ulcer or bleeding.The animals were sacrificed 3 weeks after NOTES to explore intra-peritoneal adhesions,abscesses and other infections.Results One swine died of diaphragmatic injury and the other 11 animals successfully survived for 3 weeks.In trans-gastric approach,the average bacterial load of the fluid was 17.5 x 103 CFU/ml before lavage.In control group,the average bacterial load of the fluid was 2.5 × 103 CFU/ml after lavage and 5.5 × 103 CFU/ml after NOTES,while those in experimental group were 0 CFU/ml and 7.5 CFU/ml,respectively.In trans-colonic approach,the average bacterial load of the fluid before lavage was 76.2 × 103 CFU/ml.In control group,the average bacterial load of the fluid was 19.5 × 103 CFU/ml after lavage and 21 × 103 CFU/ml after NOTES,while those in experimental group were 2.25 × 103 CFU/ml and 1 × 103 CFU/ml,respectively.No inflammation,ulcer or bleeding were observed by endoscopy at 24 hours after NOTES.More adhesion and abscess were found in the control group than in the experimental group.In experimental group with trans-colonic approach,only one case of adhesion was observed.Conclusion It is effective and feasible of using betadine solution irrigation of gastrointestinal tract in infection prevention during the procedure of NOTES.However,further clinical studies assessing the effectiveness and safety are still necessary.

Natural orifice transluminal endoscopic surgery in non-survival porcine models: access and technique / 中华消化内镜杂志

Objective To evaluate the feasibility, advantages and pitfalls of trans-gastric, trans-colonic and trans-umbilical peritoneoscopy, and to compare pure natural orifice transluminal endoscopic surgery (NOTES) with hybrid NOTES. Methods Two female pigs of 30kg were used in the study, one for pure NOTES, the other for hybrid NOTES. Each pig received trans-gastric, trans-colonic and trans-umbilical peritoneoscopy, respectively, followed by postmortem examination for organic lesions and closure of incisions.The two approaches were compared in terms of intra-operative situation and manipulation. Results The vital signs of the pigs were stable during the procedures, with no peri-incision organic lesions. There were blind areas in trans-gastric as well as in trans-colonic peritoneoscopy. It was easier to close the colonic incision than the gastric one. The situation in trans-umbilical peritoneoscopy was similar to laparoscopic surgery. Hybrid NOTES seemed superior to pure NOTES with regard to safe access, stable pneumo-peritoneum and adequate visualization. Conclusion Three routes for NOTES appear to be reasonable and feasible. Hybrid NOTES is more effective and safer than pure NOTES with current instruments.

Biliary passage dilator assisted percutaneous endoscopic gastostomy in natural orifice translumenal endoscopic surgery / 中华消化内镜杂志

Objective To explore the feasibility and safety of the biliary passage dilator assisted percutaneous endoscopic gastostomy(PEG)in natural orifice translumenal endoscopic surgery(NOTES).Methods Eleven hybrid dogs were recruited to the study.One dog was used for pilot study of biliary passage dilator assisted PEG.The rest ten were divied into 2 groups randomly(5 per group), receiving conventional PEG and biliary passage dilator assisted PEG, respectively.The efficacy and safety of these 2 methods in NOTES were compared.Two weeks later, routine gastroscopy was performed to detect the healing of luminal incision and all animals were sacrificed to explore the possible complications in the abdominal cavity.Results With the assistance of the biliary passage dilator, successful transgastric access to the peritoneal cavity was achieved in the pilot study.Biliary passage dilator assisted PEG was completed in all the 5 dogs of the experimetal group, while tradional PEG succeded in only 4.The average transgastric puncture time in the biliary passage dilator assisted PEG(7.0 ± 1.7 min)was significantly shorter than that of conventional PEG (11.0 ± 3.2 min, P ＜ 0.05).Nine dogs survived for 2 weeks postoperatively without loss of weight or peritonitis.Endoscopy showed transgastric puncture healed well.Autopsy revealed no gross adhering zone,bleeding, injury of adjacent organs or abcasses.Conclusion Compared with the conventional PEG, the biliary passage dilator assisted PEG shows the advantages of reduced difficulty and shoter time of puncture without any apparent complications.There is a good prospect of its application in NOTES.

Experimental nephrectomy via combined transgastric and transvesical approach in porcine / 第二军医大学学报

Objective: To assess the feasibility of nephrectomy via combined transgastric and transvesical approach in a porcine model, and to summarize our experience. Methods: Three female pigs were used in this study. The transvesical access was established using ureteroscope. The vesical hole was enlarged with the dilator of ureteroscope sheath and a self-designed Trocar was inserted. The gastroscope was inserted through a hole on gastric wall, which was made using a needle knife and dilator under ureteroscopy. The ultrasound knife, scissor and clips were introduced via the Trocar, and the nephrectomy was completed under the guidance of gastroscope. Results: The six kidneys of the three pigs were successfully resected, with the operation time being (132±10.5) min, without noticeable hemorrhage or complications. Mild hemorrhage occurred after ultrasonic ligation in the first nephrectomy, and was managed by clips. Clips were used to block the vessels before resection for the remaining five kidneys. Conclusion: Our method via combined approach is technically feasible for nephrectomy in a porcine model, but the kidneys have not been taken out and the puncture wounds on the bladder and gastric wall have not been closed, so further study is still needed.

Determinación de la factibilidad técnica y seguridad de un abordaje endoscópico transgástrico a la cavidad peritoneal en un modelo porcino / Determination of the technical feasibility and safety of transgastric peritoneal approach in a pig model

La viabilidad de un abordaje transgástrico para realizar peritoneoscopia y biopsia hepática ha sido demostrada en estudios previos en animales. Objetivo. Nuestro objetivo fue determinar la viabilidad y seguridad de un abordaje transgástrico peritoneal en una experiencia local. Resultados. El abordaje transgástrico con modelo similar a PEG (gastrostomía endoscópica percutánea) se realizó en 3 cerdos de la especie suis scrofa domesticus; el tiempo promedio del procedimiento fue de 102 minutos, no hubo complicaciones relacionadas con el acceso, y la necropsia no evidenció ningún daño de órganos adyacentes al estómago, aunque el cierre de la pared gástrica no fue exitoso en 2 cerdos. Conclusiones. Este estudio reporta la experiencia local con un abordaje transgástrico peroral a la cavidad peritoneal, técnicamente viable. El abordaje similar a PEG es simple y seguro, el cierre de la pared gástrica requiere destreza y mejor tecnología

Background. The feasibility of peroral transgastric peritoneoscopy and liver biopsy has been demonstrated in prior animal studies.Objective. Our purpose was to determine the feasibility and safety of transgastric peritoneal approach in local experience. Designs. Animal experimental feasibility study. Results. The peritoneal transgastric approach with PEG- like model was used in 3 pigs suis scrofa domesticus specie. The average procedure was 102 minutes, it did no have complications related to the access, and the necropsy did not reveal any damage to organs adjacent to the stomach. Nevertheless the gastric wall close was not successful in 2 pigs. Conclusions. This study report the local experience with peroral transgastric approach to peritoneal cavity, it’s technically feasible, a PEG- like transgastric model is simple and safe, the close of gastric wall requires skill and best technology.

4 Cases of Transgastric Endoscopic Cholecystectomy in Canine and Porcine Models / 대한소화기내시경학회지

Natural Orifice Transluminal Endoscopic Surgery (NOTES) is a novel therapeutic strategy. This procedure stands on the cutting edge of minimal invasive abdominal surgery that accesses the abdominal organ through natural orifices such as mouth, anus and vagina with performing gastrointestinal endoscopy. There are many animal experiments and clinical trials of NOTES along with the development of better instruments. We report here on 4 cases of transgastric endoscopic cholecystectomy in canine and porcine models, and these procedures were done through natural orifices with performing conventional endoscopy and using endoscopic devices and laparoscopic trocars.