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W1510: Transgastric Peritoneoscopy Results in a Greater Delay in Gastric Emptying Than the Laparoscopic Approach in a Novel Rat Model of Experimental NOTES®
Abstracts (43%) had a family history of cancer, in particular colorectal cancer in one patient (14%). None of the patients had a history of smoking. The histological type of cancer was well differentiated tubular adenocarcinoma and poorly differentiated adenocarcinoma in three patients (43%) each, and endocrine cell carcinoma in one (14%). [Conclusion]: Development of colorectal cancer is more likely to occur in patients with ulcerative colitis that is long-standing, and that is more extensive than left-sided colitis, particularly in those with a family history of colorectal cancer, inflammatory polyps, or dysplasia. CRCs which occurred in our patients with UC were often poorly differentiated and had a poor prognosis.
W1508 Water Immersion Technique: A Great Experience of a Single Center Lix A. Reis De Oliveira Introduction: In the last years a many of advances in the endoscopy image had occurred, but the technique of colonoscopy doesn’t differ the technique in the beginnings.We read with great intersting many recent articles talking about the immersion technique. We used the water immersion technique since 1992 in about 15000 colonoscopies. Aim:The aim of our study is to know the results of this technique comparing to actual data published with the convencional technique.Methods:We analysed prospective 1899 patients that undergo for routine colonoscopy in this clinicbetween january 2007 to july 2008 .Were excluded 47 patients with previous colon or rectum surgery. We used a high definition colonoscope and perform the procedure following this steps:1- Fullfill the air/water channel with warm water before the initial of the procedure. 2Start the procedure instilatting warm water continous pressing the air/water button totally untilk reach ileum or ceaccum.3- We start the procedure in left laterally decubit and change for dorsal decubit when we suppose were in splenic flexure( about 45cm ).4- The water that we used came from the normal bottle of water with warm water. 5- We worked in 93% of the procedures without inadivertited loops formation and worked alomost all the time with straigt form.Results:We used the medium of 2 bottles per procedure ( range 1 to 5 ) and we reach ceacum until 5 minutes in 58% and between 5-10 minutes in 30% of the procedures. It was possible to reach ileum in 99%. We found polyps in 37,77% of the patients with 2,58 polyps per patient.We performed 90% of the procedures with concious or moderate sedation. 98% of the patients classified the procedure in good and if necessary they will repeat the procedure when asked imediatelly after the colonoscopy and 95% when asked ( phone ) one day after the procedure.There were no greater complications like perforation and there were minor complications like abdominal distension in 16% of the patients ( phone )Conclusions:1- Our results are comparable with the conventional technique.2- The technique is cheap and safe.3- Cecal intubation is speed and painless.4- Safe for the colonoscope.
W1509 Development of a 3-D LEGO®-Model of the Stomach for Preclinical Studies Using Innovative Endoscopes and Educational Training Helmut Neumann, Markus F. Neurath, Philipp Scha¨fer, Henrik Keller, Rainer Kuth Background: While there is an emerging attempt for the development of new endoscopic techniques operators often suffer from difficulties arising from appropriate biosimulation models for preclinical studies. Here, we present a novel method for 3D-reconstruction of the stomach, which can be used as a proper and flexible tool for preclinical studies using innovative endoscopes and educational training. Aim: To assess a proper method for 3D-reconstruction of the stomach which can be used for preclinical studies and educational training. Methods: The LEGO® Digital Designer (LEGO® Group, Billund, Denmark), a virtual building software, was used to build a model resembling the human stomach. Afterwards, the model was assembled using standard LEGO® bricks. Repeated trials were done to test the full functionality and versatility of different endoscopes within the model.Results: A new, flexible and proper method for 3D-reconstruction of the stomach was developed and tested. The model could be filled with water and other liquids for training and simulation purposes. Furthermore, the inner side could be covered with various materials allowing the simulation of different environments. Opening the model before, during and after each study allows rapid access and observation of the procedure.Conclusions: 3D-models assembled using LEGO® bricks represent proper and flexible tools for preclinical studies using innovative endoscopes and educational training.
AB346 GASTROINTESTINAL ENDOSCOPY
Volume 71, No. 5 : 2010
W1510 Transgastric Peritoneoscopy Results in a Greater Delay in Gastric Emptying Than the Laparoscopic Approach in a Novel Rat Model of Experimental NOTES® Jianqiang Guo, Mohan M. Shenoy, Liansheng Liu, Pankaj J. Pasricha Background. Natural orifice translumenal endoscopic surgery (NOTES) my cause less physiological derangement and pain although this has not been proven conclusively in either animals or humans. Our aim was to create a rat model to compare the effects of NOTES with laparoscopy on inflammation, nociception and gastrointestinal motility, that would allow this hypothesis to be tested. Methods. Male Sprague-Dawley rats (weighing ⬃ 360 gm) were divided into two groups, NOTES and LAP. Rats were anesthetized by ketamine/xylazine, underwent endotracheal intubation and ventilation. In the NOTES group, a flexible bronchoscope (ø3.7 mm) was introduced into the stomach, and a 19g EUS/FNA stylet was used to puncture the stomach. The gastrostomy was then expanded by a balloon catheter and the bronchoscope pushed into the peritoneal cavity. The peritoneal cavity was insufflated with air and a careful protocolized inspection of the organs was made for 3 minutes. The scope was then withdrawn into the stomach pulling a piece of omentum with it to plug the gastrotomy. In the LAP procedure, a small incision was made in the right abdominal wall with a scalpel and the bronchoscope was inserted into the abdominal cavity. Pneumoperitoneum was established and inspection carried out, identical to the NOTES procedure, followed by suturing of the incision in the abdominal wall. Gastric emptying was measured using a liquid phenol red solution 2 hours after recovery in both groups. In other animals, the spinal cord was harvested after intracardiac perfusion and stained for the immediate early gene product, FOS, a marker for activation of spinal nociceptive pathways. At sacrifice, serum and peritoneal washings were collected for cytokine analysis by a multiplex Lumina assay.Results. Rats survived the NOTES procedure well. In separate experiments, the fidelity of the gastric sealing was established and no leak was seen in the peritoneal cavity. Recovery time (defined as time to an awake and mobile state) was not significantly different in the two groups (NOTES versus LAP, 110 ⫾ 26 versus 78 ⫾ 18 minutes, p⫽0.1). Gastric emptying studies revealed that liquid emptying was markedly delayed in the NOTES group compared to the LAP group (24.6⫾12.6 versus 60.8⫾12.1 at 2 hours; P ⫽ 0.02). Spinal FOS and cytokine analysis is ongoing, as are the effects on small bowel motility. Conclusion. NOTES is feasible in a rat model. This will facilitate the scientific approach to hypothesis testing for this novel approach to surgery. Our preliminary results indicate that transgastric peritoneoscopy results in significantly greater impairment of gastric emptying than a laparoscopic approach
W1511 Natural Orifice Endoscopic Surgery Gastrotomy Closure: A Survival Porcine Study Carlos Guarner-Argente, Henry Cordova, Graciela Martı´nez-Pallı´, Ricard Navarro-Ripoll, Cristina Rodriguez De Miguel, Mireia Beltran, Josep Llach, Angels Gines, Maria Pellise, Oriol Sendino, Josep M. Bordas, Gloria Fernandez-Esparrach BACKGROUND: Secure closure of the gastrotomy access is one of the most important issues for the development of natural orifice endoscopic surgery (NOTES).AIM: To evaluate the feasibility, reproducibility and security of a transluminal closure device in a porcine survival model.MATERIALS AND PROCEDURES: Ten female Yorkshire pigs weighting 30-35 Kg were included in the study. Gastrotomies were performed using a 5 mm needle-knife incision and balloon dilation. Posterior gastric closure was attempted using Brace-bar prototype closure devices. Clips were added only when necessary. All animals were monitored daily for signs of peritonitis and sepsis during the next 14 days. During necropsy, the peritoneal cavity and the gastric access site were examined.RESULTS: Transgastric access, closure and 14 days survival period was achieved in all pigs. The mean closure time was 18.1⫾19.2 minutes and a mean of 2.1⫾1 (range 1-4) devices were used to achieve secure closure, although only 1.5⫾0.5 (range 1-2) were correctly placed. Supplementary clips were necessary in only 2 cases. The closure time was progressively reduced (24.8⫾13.9 in the first 5 pigs and 11.4⫾5.9 in he last 5, p⫽NS). Mean weight gain at day 14 was 3.25⫾3.2 KG (range -2.8, 6.9). At necropsy, the gastric access site was correctly closed in all cases and all Brace-bars were present. Only one device was misplaced in the colon. Minimal adhesions were observed in 3 pigs and signs of peritonitis in 1.CONCLUSIONS: the use of Brace-bar is feasible, reproducible and secure in porcine stomachs. A short learning curve is required but the use of pre-charged devices might improve the procedure time. Further studies are necessary.
W1512 Endoscopic Management of Visceral Injuries During NOTES®: A Blinded Study in a Porcine Model Christopher J. Fyock, Christopher E. Forsmark, Mihir S. Wagh Introduction: Accidental visceral injury is a potentially life-threatening complication that may occur during Natural Orifice Translumenal Endoscopic
www.giejournal.org
W1508 Water Immersion Technique: A Great Experience of a Single Center Lix A. Reis De Oliveira Introduction: In the last years a many of advances in the endoscopy image had occurred, but the technique of colonoscopy doesn’t differ the technique in the beginnings.We read with great intersting many recent articles talking about the immersion technique. We used the water immersion technique since 1992 in about 15000 colonoscopies. Aim:The aim of our study is to know the results of this technique comparing to actual data published with the convencional technique.Methods:We analysed prospective 1899 patients that undergo for routine colonoscopy in this clinicbetween january 2007 to july 2008 .Were excluded 47 patients with previous colon or rectum surgery. We used a high definition colonoscope and perform the procedure following this steps:1- Fullfill the air/water channel with warm water before the initial of the procedure. 2Start the procedure instilatting warm water continous pressing the air/water button totally untilk reach ileum or ceaccum.3- We start the procedure in left laterally decubit and change for dorsal decubit when we suppose were in splenic flexure( about 45cm ).4- The water that we used came from the normal bottle of water with warm water. 5- We worked in 93% of the procedures without inadivertited loops formation and worked alomost all the time with straigt form.Results:We used the medium of 2 bottles per procedure ( range 1 to 5 ) and we reach ceacum until 5 minutes in 58% and between 5-10 minutes in 30% of the procedures. It was possible to reach ileum in 99%. We found polyps in 37,77% of the patients with 2,58 polyps per patient.We performed 90% of the procedures with concious or moderate sedation. 98% of the patients classified the procedure in good and if necessary they will repeat the procedure when asked imediatelly after the colonoscopy and 95% when asked ( phone ) one day after the procedure.There were no greater complications like perforation and there were minor complications like abdominal distension in 16% of the patients ( phone )Conclusions:1- Our results are comparable with the conventional technique.2- The technique is cheap and safe.3- Cecal intubation is speed and painless.4- Safe for the colonoscope.
W1509 Development of a 3-D LEGO®-Model of the Stomach for Preclinical Studies Using Innovative Endoscopes and Educational Training Helmut Neumann, Markus F. Neurath, Philipp Scha¨fer, Henrik Keller, Rainer Kuth Background: While there is an emerging attempt for the development of new endoscopic techniques operators often suffer from difficulties arising from appropriate biosimulation models for preclinical studies. Here, we present a novel method for 3D-reconstruction of the stomach, which can be used as a proper and flexible tool for preclinical studies using innovative endoscopes and educational training. Aim: To assess a proper method for 3D-reconstruction of the stomach which can be used for preclinical studies and educational training. Methods: The LEGO® Digital Designer (LEGO® Group, Billund, Denmark), a virtual building software, was used to build a model resembling the human stomach. Afterwards, the model was assembled using standard LEGO® bricks. Repeated trials were done to test the full functionality and versatility of different endoscopes within the model.Results: A new, flexible and proper method for 3D-reconstruction of the stomach was developed and tested. The model could be filled with water and other liquids for training and simulation purposes. Furthermore, the inner side could be covered with various materials allowing the simulation of different environments. Opening the model before, during and after each study allows rapid access and observation of the procedure.Conclusions: 3D-models assembled using LEGO® bricks represent proper and flexible tools for preclinical studies using innovative endoscopes and educational training.
AB346 GASTROINTESTINAL ENDOSCOPY
Volume 71, No. 5 : 2010
W1510 Transgastric Peritoneoscopy Results in a Greater Delay in Gastric Emptying Than the Laparoscopic Approach in a Novel Rat Model of Experimental NOTES® Jianqiang Guo, Mohan M. Shenoy, Liansheng Liu, Pankaj J. Pasricha Background. Natural orifice translumenal endoscopic surgery (NOTES) my cause less physiological derangement and pain although this has not been proven conclusively in either animals or humans. Our aim was to create a rat model to compare the effects of NOTES with laparoscopy on inflammation, nociception and gastrointestinal motility, that would allow this hypothesis to be tested. Methods. Male Sprague-Dawley rats (weighing ⬃ 360 gm) were divided into two groups, NOTES and LAP. Rats were anesthetized by ketamine/xylazine, underwent endotracheal intubation and ventilation. In the NOTES group, a flexible bronchoscope (ø3.7 mm) was introduced into the stomach, and a 19g EUS/FNA stylet was used to puncture the stomach. The gastrostomy was then expanded by a balloon catheter and the bronchoscope pushed into the peritoneal cavity. The peritoneal cavity was insufflated with air and a careful protocolized inspection of the organs was made for 3 minutes. The scope was then withdrawn into the stomach pulling a piece of omentum with it to plug the gastrotomy. In the LAP procedure, a small incision was made in the right abdominal wall with a scalpel and the bronchoscope was inserted into the abdominal cavity. Pneumoperitoneum was established and inspection carried out, identical to the NOTES procedure, followed by suturing of the incision in the abdominal wall. Gastric emptying was measured using a liquid phenol red solution 2 hours after recovery in both groups. In other animals, the spinal cord was harvested after intracardiac perfusion and stained for the immediate early gene product, FOS, a marker for activation of spinal nociceptive pathways. At sacrifice, serum and peritoneal washings were collected for cytokine analysis by a multiplex Lumina assay.Results. Rats survived the NOTES procedure well. In separate experiments, the fidelity of the gastric sealing was established and no leak was seen in the peritoneal cavity. Recovery time (defined as time to an awake and mobile state) was not significantly different in the two groups (NOTES versus LAP, 110 ⫾ 26 versus 78 ⫾ 18 minutes, p⫽0.1). Gastric emptying studies revealed that liquid emptying was markedly delayed in the NOTES group compared to the LAP group (24.6⫾12.6 versus 60.8⫾12.1 at 2 hours; P ⫽ 0.02). Spinal FOS and cytokine analysis is ongoing, as are the effects on small bowel motility. Conclusion. NOTES is feasible in a rat model. This will facilitate the scientific approach to hypothesis testing for this novel approach to surgery. Our preliminary results indicate that transgastric peritoneoscopy results in significantly greater impairment of gastric emptying than a laparoscopic approach
W1511 Natural Orifice Endoscopic Surgery Gastrotomy Closure: A Survival Porcine Study Carlos Guarner-Argente, Henry Cordova, Graciela Martı´nez-Pallı´, Ricard Navarro-Ripoll, Cristina Rodriguez De Miguel, Mireia Beltran, Josep Llach, Angels Gines, Maria Pellise, Oriol Sendino, Josep M. Bordas, Gloria Fernandez-Esparrach BACKGROUND: Secure closure of the gastrotomy access is one of the most important issues for the development of natural orifice endoscopic surgery (NOTES).AIM: To evaluate the feasibility, reproducibility and security of a transluminal closure device in a porcine survival model.MATERIALS AND PROCEDURES: Ten female Yorkshire pigs weighting 30-35 Kg were included in the study. Gastrotomies were performed using a 5 mm needle-knife incision and balloon dilation. Posterior gastric closure was attempted using Brace-bar prototype closure devices. Clips were added only when necessary. All animals were monitored daily for signs of peritonitis and sepsis during the next 14 days. During necropsy, the peritoneal cavity and the gastric access site were examined.RESULTS: Transgastric access, closure and 14 days survival period was achieved in all pigs. The mean closure time was 18.1⫾19.2 minutes and a mean of 2.1⫾1 (range 1-4) devices were used to achieve secure closure, although only 1.5⫾0.5 (range 1-2) were correctly placed. Supplementary clips were necessary in only 2 cases. The closure time was progressively reduced (24.8⫾13.9 in the first 5 pigs and 11.4⫾5.9 in he last 5, p⫽NS). Mean weight gain at day 14 was 3.25⫾3.2 KG (range -2.8, 6.9). At necropsy, the gastric access site was correctly closed in all cases and all Brace-bars were present. Only one device was misplaced in the colon. Minimal adhesions were observed in 3 pigs and signs of peritonitis in 1.CONCLUSIONS: the use of Brace-bar is feasible, reproducible and secure in porcine stomachs. A short learning curve is required but the use of pre-charged devices might improve the procedure time. Further studies are necessary.
W1512 Endoscopic Management of Visceral Injuries During NOTES®: A Blinded Study in a Porcine Model Christopher J. Fyock, Christopher E. Forsmark, Mihir S. Wagh Introduction: Accidental visceral injury is a potentially life-threatening complication that may occur during Natural Orifice Translumenal Endoscopic
www.giejournal.org