Diagnostic transgastric endoscopic peritoneoscopy: extension of the initial human trial for staging of pancreatic head masses

Abstract

This study supports the authors' previous conclusions that the transgastric approach to diagnostic peritoneoscopy is feasible, safe, and accurate. The lack of documented bacterial contamination further supports the use of this technique. Technical issues, including intraabdominal manipulation and gastric closure, require further investigation.

The Second SAGES/ASGE White Paper on natural orifice transluminal endoscopic surgery: 5 years of progress

“…The preliminary results look very promising, though studies comparing it to laparoscopic Heller myotomy are now needed [15]. • Staging peritoneoscopy for GI malignancies was also widely discussed and was felt to be a procedure that might provide great benefit to patients but also be practicable with current technologies [16]. It was also felt that this might be a procedure readily adapted to the practices of gastroenterologists as well as surgeons.…”

Transgastric endoscopic peritoneoscopy does not lead to increased risk of infectious complications

“…In this study, the issue of gastrotomy closure was circumvented with the application of endoscopic peritoneoscopy for patients undergoing LRYGB surgery. With the addition of the 40 patients in the current study, our group has investigated the risk of postoperative infections for 100 patients undergoing transgastric instrumentation in the context of NOTES and non-NOTES settings [14][15][16]. There has been documented cross-contamination between the gastric lumen and the abdominal cavity.…”

“…No NOTES procedures were performed in this investigation. Our next study examined the feasibility of transgastric diagnostic peritoneoscopy for evaluating the resectability of pancreatic head masses in 10 patients [15,16]. In these patients, bacterial data again was recorded.…”

A review of 130 humans enrolled in transgastric NOTES protocols at a single institution

“…With that said, the preponderance of data for the therapeutic application of NOTES currently available in humans incorporates the transvaginal approach. Presently, there are only six publications from North America on transgastric NOTES protocols in a human population [7][8][9][10][11][12]. Natural orifice surgery may represent the next permutation in minimally invasive techniques, marking a shift from the laparoscopic or open approach.…”