Endoscopic treatment for gastric perforation using T-tag and a plastic protection chamber: a short-term survival study.

CONTEXT: The endoscopic gastric perforation is a consequence of some endoscopic procedures and now a way to manage abdominal organs. This is the reason why endoscopists are studying a safe endoscopic repair. OBJECTIVE: To evaluate an endoscopic closure method for the gastric opening in natural orifice transenteric surgery DESIGN: Short-term survival animal study. METHODS: Ten White Landrace pigs underwent a gastric perforation of 1.8 cm in diameter under general anesthesia. The opening was repaired with stitch assembled in a T-tag anchor placed through the gastric wall with a needle. A plastic transparent chamber, adapted to the endoscope tip protected the abdominal organs from the needle puncture outside the stomach. Six T-tags were placed in most cases and the stitches were tied with a metallic tie-knot, forming three sutures. The animals received liquids in the same operative day. One shoot antibiotic was used. The leakage test was performed with a forceps and by air distention. RESULTS: No complication was detected in the postoperative course. One month later the endoscopy revealed a scar and some suture material was observed in all animals. The antral anterior gastric wall was clear with few adhesions in the laparotomy performed in the same time. The adhesions were intense in an animal in which a cholecystectomy was performed before the repair. CONCLUSION: The endoscopic repair using T-tag and a protector chamber is feasible, easy to perform and safe. Further studies are needed to show the real value of this kind of procedure.

Expandable gastric port for natural orifice translumenal endoscopic surgery.

BACKGROUND: The risk of intraabdominal contamination is a critical consideration during most natural orifice translumenal endoscopic surgery (NOTES) procedures. OBJECTIVE: The objective of this study was to determine a safe and efficient pathway for the endoscope in a transgastric NOTES procedure. DESIGN AND SETTINGS: A pilot experimental study in live pigs was performed. METHODS: Five White Landrace pigs, weighing approximately 30-35 kg, underwent the placement of a device consisting of an expandable sheath, the distal portion of which was composed of a fully covered self-expanding metal stent, and an introducer made with an outer catheter, a pushing catheter, and an inner, guiding catheter. The sheath was attached to the stent by suturing it in place. The initial gastric opening was made by means of a needle knife papilotome with electrocoagulation, aimed to the anterior gastric wall. Then, it was dilated with an endoscopic 1.8-cm balloon. The set was introduced over a Savary guidewire. After the set placement, the outer tube was slowly retrieved. Finally, the delivery system was removed from the pig, leaving the entire endoscopic port in place. RESULTS: The expandable gastric port was placed without difficulty in all animals. Endoscope insertion into the expandable gastric port was very easily performed. The endoscope had a wide range of movement inside the peritoneal cavity. The gastric port sealed the gastric wall, avoiding gross contamination of the peritoneal cavity and maintaining the pneumoperitoneum without excessive inflation of the intestine. CONCLUSIONS: Use of a gastric port can minimize contamination of the peritoneal cavity due to the spillage of gastric contents during a transgastric NOTES procedure and can also facilitate performance of the procedure.

Endoscopic treatment for gastric perforation using T-tag and a plastic protection chamber: a short-term survival study / Tratamento endoscópico para perfuração gástrica por sutura utilizando dispositivos em T associados à câmara plástica protetora: estudo com curto tempo de sobrevida

CONTEXT: The endoscopic gastric perforation is a consequence of some endoscopic procedures and now a way to manage abdominal organs. This is the reason why endoscopists are studying a safe endoscopic repair. OBJECTIVE: To evaluate an endoscopic closure method for the gastric opening in natural orifice transenteric surgery DESIGN: Short-term survival animal study. METHODS: Ten White Landrace pigs underwent a gastric perforation of 1.8 cm in diameter under general anesthesia. The opening was repaired with stitch assembled in a T-tag anchor placed through the gastric wall with a needle. A plastic transparent chamber, adapted to the endoscope tip protected the abdominal organs from the needle puncture outside the stomach. Six T-tags were placed in most cases and the stitches were tied with a metallic tie-knot, forming three sutures. The animals received liquids in the same operative day. One shoot antibiotic was used. The leakage test was performed with a forceps and by air distention. RESULTS: No complication was detected in the postoperative course. One month later the endoscopy revealed a scar and some suture material was observed in all animals. The antral anterior gastric wall was clear with few adhesions in the laparotomy performed in the same time. The adhesions were intense in an animal in which a cholecystectomy was performed before the repair. CONCLUSION: The endoscopic repair using T-tag and a protector chamber is feasible, easy to perform and safe. Further studies are needed to show the real value of this kind of procedure.

CONTEXTO: A perfuração gástrica pode ser consequência de alguns procedimentos endoscópicos, atualmente, produzida intencionalmente para acesso a alguns órgãos com o advento da cirurgia transluminal endoscópica por orifícios naturais. Esta é a razão para que os endoscopistas estudem uma maneira segura de reparar estas lesões por via endoscópica. OBJETIVO: Avaliar um novo método de fechamento das perfurações gástricas utilizadas para acesso ao NOTES. MODELO DE ESTUDO: Pesquisa em modelos animais com curto tempo de sobrevida. MÉTODO: Dez porcos da raça White Landrace, foram submetidos a perfuração gástrica de 1,8 cm, monitorizados e sob anestesia geral. A abertura gástrica foi reparada com dispositivo especial constituído por agulha em forma de T montada com fio (T-tag), inserida, por via endoscópica, nas bordas do ferimento perfurando a parede gástrica e fixando-se a ela como uma âncora. Uma câmara plástica protetora, especialmente desenvolvida, foi adaptada à ponta do endoscópio para proteção dos órgãos subjacentes. Seis T-tags foram inseridos na maioria dos casos e os pontos foram amarrados e fixados com auxílio de outro dispositivo metálico de contenção do nó denominado “tie-knot”, formando três suturas. Um teste de vazamento do tipo manobra do borracheiro era realizado ao término do procedimento. Os animais recebiam líquido no pós-operatório imediato. Foi usada profilaxia antibiótica. RESULTADOS: Não houve complicações. Um mês depois, a endoscopia de controle revelou cicatriz e alguns restos de sutura. A laparotomia, feita no mesmo tempo, revelou poucas aderências na face anterior do antro. CONCLUSÃO: O reparo endoscópico com T-tags e câmara protetora parece ser efetiva, fácil e segura. Estudos maiores e com maior tempo são necessários para confirmar estes resultados e a utilidade deste procedimento.

Análise crítica dos métodos endoscópicos alternativos de acesso à via biliar / Critical analysis of the alternatives endoscopic methods to achieve access to the bile duct

Racional - A colangiopancreatografia retrógrada endoscópica desempenha, desde a sua introdução, papel cada vez mais importante no diagnóstico e tratamento dos distúrbios biliopancreáticos. Objetivo - Apresentar uma análise da utilização dos métodos endoscópicos alternativos de acesso à via biliar nas situações em que esta não foi alcançada pelo método convencional. Casuística e Método - Entre janeiro de 1997 e dezembro de 2000, 207 pacientes foram submetidos a colangiopancreatografia endoscópica retrógrada pelo método convencional, sendo que 20 destes também foram submetidos aos métodos alternativos. Resultados - O método convencional isolado obteve sucesso em 86,5% dos casos com 2,42% de complicações. A utilização dos métodos alternativos contribuiu significativamente para elevação desta taxa para 94,7%, sem aumento de complicação. Conclusões - Os métodos convencionais constituem procedimentos de eleição no acesso à via biliar pelo seu alto índice de sucesso e baixa morbidade. Os métodos alternativos constituem importante recurso diagnóstico e terapêutico nos casos de insucesso dos métodos convencionais.