Transgastric Endoscopic Peritoneoscopy Does Not Require Decontamination of the Stomach in Humans

Introduction: Natural Orifice Transluminal Endoscopic Surgery (NOTES) is a rapidly evolving field that provides endoscopic access to the peritoneum via a natural orifice. One important requirement of this technique is the need to minimize the risk of clinically significant peritoneal contamination. We report the bacterial load and contamination of the peritoneal cavity in patients undergoing diagnostic transgastric endoscopic peritoneoscopy.
Methods: Patients participating in this trial were scheduled to undergo diagnostic laparoscopy for evaluation of presumed pancreatic cancer. Findings at diagnostic laparoscopy were compared to that of diagnostic transgastric endoscopic peritoneoscopy, using an orally placed gastroscope, blinding the endoscopist to the laparoscopic findings. No gastric decontamination was used. Diagnostic findings, operative times and clinical course were recorded. Gastric and peritoneal fluid aspirates were obtained prior to and after the gastrotomy. Each sample was sent for bacterial colony counts, culture and identification of species.
Results: Six patients have completed the protocol with an average age of 63 yrs. All patients underwent diagnostic laparoscopy followed by successful transgastric access and diagnostic peritoneoscopy. The average time for transgastric instrumentation was 28 minutes compared to 13 minutes for laparoscopy. . Bacterial sampling was available in 4 of 6 patients. The average number of colony forming units (CFU) in the gastric aspirate was 181.9 CFU/ml, peritoneal aspirates prior to creation of a gastrotomy showed 25 CFU/ml, and peritoneal sampling after gastrotomy had an average of 116.9 CFU/ml. There was no cross contamination of the peritoneal cavity with species isolated from the gastric aspirate. No infectious complications or leaks developed postoperatively.
Conclusions: There was no clinically significant contamination of the abdominal cavity after transgastric endoscopic instrumentation of the peritoneal cavity in humans. Transgastric instrumentation does contaminate the abdominal cavity but pathogens are clinically insignificant due to species or bacterial load.

Session: Podium Presentation

Program Number: S038