A novel safe approach to the peritoneal cavity for per-oral transgastric endoscopic procedures

Background: We have previously reported the feasibility and safety of per-oral transgastric endoscopic procedures in a porcine model. Objective: Our purpose was to evaluate the safety and feasibility of a PEG-like approach to the peritoneal cavity. Settings: Acute experiments on 50-kg pigs under general anesthesia. Design and Interventions: After per-oral intubation, the endoscope was positioned into the body of the stomach, the anterior abdominal wall was transilluminated and punctured with a needle, and a guidewire was inserted into the stomach through the needle. The guidewire was grasped with endoscopic forceps and pulled through the biopsy channel of the endoscope. A sphincterotome was inserted into the gastric wall over the guidewire. Gastric incision was performed and the endoscope was advanced into the peritoneal cavity. The peritoneal cavity was insufflated and endoscopic peritoneoscopy was performed. Then the animal was euthanized and necropsy was performed. Main Outcome Measures: Safety of transgastric entrance to peritoneal cavity. Results: The PEG-like approach was used in 12 pigs. The average procedure time was 11.4 ± 3.7 minutes. There was only 1 complication related to the access: bleeding from the gastric wall incision was documented when a pure cut (without coagulation) current was used for incision of the gastric wall. There were no complications in the other 11 pigs. The necropsy did not reveal any damage to organs adjacent to the stomach. Limitations: Gastric wall incision is located on anterior gastric wall. Conclusions: The PEG-like transgastric approach to the peritoneal cavity appears technically simple and safe.