Endoscopic peritoneal access and insufflation

natural orifice transluminal endoscopic surgery

Peter Nau, Joel Anderson, Bradley Needleman, E. Christopher Ellison, W. Scott Melvin, Jeffrey W. Hazey

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background: Diagnostic transgastric endoscopic peritoneoscopy is a safe model for exploration of the peritoneum. Endoscopic insufflation of the peritoneal cavity has not been validated in humans. We report here our experience with pneumoperitoneum established endoscopically with a laparoscopic insufflator. Design: Pneumoperitoneum was established with a laparoscopic insufflator through the biopsy channel of the gastroscope. Intra-abdominal pressure was measured with a transfascial Veress needle and compared with endoscopic values. The gastrotomy was used in the creation of the gastric pouch. Patients: Twenty patients undergoing laparoscopic Roux-en-Y gastric bypass participated in the study. Ten had undergone no previous surgery, whereas the other 10 patients had a history of abdominal procedures. Interventions: Diagnostic transgastric endoscopic peritoneoscopy was performed through a gastrotomy created endoscopically without laparoscopic visualization. Main Outcome Measurements: Diagnostic findings, operating times, and clinical course were recorded. Results: The average time for transgastric access was 9.6 minutes. This did not vary in patients with previous surgery (P = .3). Endoscopic insufflation was successful in all patients. The mean endoscopic and laparoscopic pressures were 9.80 and 9.75 mm Hg, respectively (P = .9). In no patients were there limitations to visualization of the abdomen. Adhesions were noted in 80% and 10% of patients with and without a history of surgery, respectively (P = .005). There were no complications related to transgastric passage of the endoscope or exploration of the peritoneal cavity. Conclusions: Although limited by the small sample size in this study, we believe that transgastric access may be considered as an alternative approach to peritoneal insufflation and provides a safe alternative for exploration of the abdomen. Endoscopic insufflation through the biopsy channel by using a laparoscopic insufflator seems to be an effective and safe method for establishing pneumoperitoneum.

Original languageEnglish (US)
Pages (from-to)485-489
Number of pages5
JournalGastrointestinal Endoscopy
Volume71
Issue number3
DOIs
StatePublished - Mar 2010
Externally publishedYes

Fingerprint

Natural Orifice Endoscopic Surgery
Insufflation
Pneumoperitoneum
Peritoneal Cavity
Abdomen
Laparoscopy
Gastroscopes
Biopsy
Pressure
Gastric Bypass
Endoscopes
Peritoneum
Sample Size
Needles
Stomach

ASJC Scopus subject areas

  • Gastroenterology
  • Radiology Nuclear Medicine and imaging

Cite this

Endoscopic peritoneal access and insufflation : natural orifice transluminal endoscopic surgery. / Nau, Peter; Anderson, Joel; Needleman, Bradley; Ellison, E. Christopher; Melvin, W. Scott; Hazey, Jeffrey W.

In: Gastrointestinal Endoscopy, Vol. 71, No. 3, 03.2010, p. 485-489.

Research output: Contribution to journalArticle

Nau, Peter ; Anderson, Joel ; Needleman, Bradley ; Ellison, E. Christopher ; Melvin, W. Scott ; Hazey, Jeffrey W. / Endoscopic peritoneal access and insufflation : natural orifice transluminal endoscopic surgery. In: Gastrointestinal Endoscopy. 2010 ; Vol. 71, No. 3. pp. 485-489.
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