471 Closure of Gastrostomy with Gastropexy for NOTES®

BackgroundDevelopment of safe entrance into the peritoneal cavity and reliable closure of the gastric wall incision remain the major challenges for safe introduction of NOTES procedures into clinical practice in humans.ObjectiveTo evaluate in a live porcine survival model transgastric access and closure techniques utilizing principles of percutaneous endoscopic gastrostomy (PEG) combined with a gastropexy.Material and MethodsTen 50-kg pigs were included in the study. By using a surgical suture passer under endoscopic guidance, 3 percutaneous sutures were placed in a triangular fashion through the gastric wall. Then the gastric wall was punctured in the center of the 3 sutures. A guide-wire was advanced through the puncture into the peritoneal cavity and a gastrotomy was created with a dilation balloon. The endoscope was introduced through gastrotomy into the peritoneal cavity. After performing a NOTES procedure, the gastrotomy was closed by tying the previously placed sutures. Endoscopic control through rectal or vaginal access way was performed betweed 2 - 4 week before planned necropsy.ResultsThe gastrotomies were successfully created and closed in all 10 animals. The 10 pigs survived without any adverse events until planned necropsy at 2 to 4 weeks. In all animals the necropsy have not reveal any signs of gastric content leakage or peritonitis and all gastrotomy sites healed very well, and remained attached to the abdominal wall, with histological confirmation.ConclusionThe PEG and gastropexy are well established and standardized procedures in humans, very familiar to gastroenterologists. Use of PEG with subsequent gastopexy could also become a safe and effective NOTES entrance and closure techniques in humans. BackgroundDevelopment of safe entrance into the peritoneal cavity and reliable closure of the gastric wall incision remain the major challenges for safe introduction of NOTES procedures into clinical practice in humans. Development of safe entrance into the peritoneal cavity and reliable closure of the gastric wall incision remain the major challenges for safe introduction of NOTES procedures into clinical practice in humans. ObjectiveTo evaluate in a live porcine survival model transgastric access and closure techniques utilizing principles of percutaneous endoscopic gastrostomy (PEG) combined with a gastropexy. To evaluate in a live porcine survival model transgastric access and closure techniques utilizing principles of percutaneous endoscopic gastrostomy (PEG) combined with a gastropexy. Material and MethodsTen 50-kg pigs were included in the study. By using a surgical suture passer under endoscopic guidance, 3 percutaneous sutures were placed in a triangular fashion through the gastric wall. Then the gastric wall was punctured in the center of the 3 sutures. A guide-wire was advanced through the puncture into the peritoneal cavity and a gastrotomy was created with a dilation balloon. The endoscope was introduced through gastrotomy into the peritoneal cavity. After performing a NOTES procedure, the gastrotomy was closed by tying the previously placed sutures. Endoscopic control through rectal or vaginal access way was performed betweed 2 - 4 week before planned necropsy. Ten 50-kg pigs were included in the study. By using a surgical suture passer under endoscopic guidance, 3 percutaneous sutures were placed in a triangular fashion through the gastric wall. Then the gastric wall was punctured in the center of the 3 sutures. A guide-wire was advanced through the puncture into the peritoneal cavity and a gastrotomy was created with a dilation balloon. The endoscope was introduced through gastrotomy into the peritoneal cavity. After performing a NOTES procedure, the gastrotomy was closed by tying the previously placed sutures. Endoscopic control through rectal or vaginal access way was performed betweed 2 - 4 week before planned necropsy. ResultsThe gastrotomies were successfully created and closed in all 10 animals. The 10 pigs survived without any adverse events until planned necropsy at 2 to 4 weeks. In all animals the necropsy have not reveal any signs of gastric content leakage or peritonitis and all gastrotomy sites healed very well, and remained attached to the abdominal wall, with histological confirmation. The gastrotomies were successfully created and closed in all 10 animals. The 10 pigs survived without any adverse events until planned necropsy at 2 to 4 weeks. In all animals the necropsy have not reveal any signs of gastric content leakage or peritonitis and all gastrotomy sites healed very well, and remained attached to the abdominal wall, with histological confirmation. ConclusionThe PEG and gastropexy are well established and standardized procedures in humans, very familiar to gastroenterologists. Use of PEG with subsequent gastopexy could also become a safe and effective NOTES entrance and closure techniques in humans. The PEG and gastropexy are well established and standardized procedures in humans, very familiar to gastroenterologists. Use of PEG with subsequent gastopexy could also become a safe and effective NOTES entrance and closure techniques in humans.