Abstracts
2000 Digestive Disease Week

# 2284 Flexible Transgastric Peritoneoscopy: A Novel Approach to Diagnostic and Therapeutic Interventions in the Peritoneal Cavity.
Anthony N. Kalloo, Sergey V. Kantsevoy, Vikesh K. Singh, Carolyn A. Magee, Cheryl A. Vaughn, Susan L. Hill, Apollo Group, Baltimore, MD

The traditional approach to the peritoneal cavity is by trans-abdominal wall incision, and more recently by the less invasive laparoscopic surgery. We evaluated the feasibility, efficacy and safety of an endoscopic transgastric approach to the peritoneal cavity in a porcine model with longterm survival. Methods: 45-50kg pigs had initial endoscopic needle-knife incisions of the gastric wall followed by balloon dilatation/ electrocautery of incision under general anesthesia using sterile techniques. Antibiotic irrigation of stomach was performed prior to initial incision for pigs #3,4,5. The endoscope underwent high level disinfection followed by gas sterilization and was advanced via sterile overtube into the peritoneal cavity for peritoneoscopy and liver biopsy. The gastric incision was subsequently closed with endoclips®(Olympus). The pigs were survived for 14 days and then sacrificed. Peritoneal cultures, endoscopic and pathologic examinations were performed. Results: 5 pigs had gastric incisions that were easily performed with rapid access to the peritoneal cavity using a sterile endoscope. Insufflation of the peritoneal cavity was quick and the view of the intra-abdominal organs was spectacular. The intra-abdominal and pelvic organs were readily seen and accessed for complete examination. Directed liver biopsies were easily performed and closure of gastric incision was successful in all pigs. All pigs were able to tolerate a regular diet within 24 hours, eat heartily and thrive over the next 14 days with a mean weight gain of 7.1pounds(±2.6 pounds, 95%C.I.(3.87,10.3) Endoscopic follow-up of the stomach was normal.4/5 pigs had negative follow-up cultures. 1/5 pig had Proteus sp. Grossly, 2/5 pigs had normal stomachs, pathologically 2/5 pigs had microabscesses (pigs#1,2) and 1/5 pig had remote inflammation only. None of the pigs that had antibiotic irrigation of the stomach developed microabscesses. Conclusion: This study is the first to show that the transgastric endoscopic access of the peritoneal cavity with prolonged survival is feasible in the porcine model. This suggests that the endoscopic/ transgastric approach to the peritoneal cavity may have potential for a wide range of surgical interventions. (The Apollo Group: Sydney Chung, Peter Cotton, Christopher Gostout, Robert Hawes, Anthony Kalloo, Pankaj Pasricha, Thadeus Trus).