2216 Endoscopic gastric perforation repair with omental patch, using endoscopic clips.

Abstract

INTRODUCTION - Perforation of the digestive tract wall is a complication of some therapeutic procedures. In such an event, the endoscopic repair is less invasive and its performance has been reported in several cases. On the other hand, the idea of using an omental patch for such repairs has been applied for a long time to the surgical treatment of gastroduodenal ulcer perforation. This study shows the results of combining both techniques and allows to establish a guideline for this kind of repair. METHOD -Ten threecross Large White, Landrace and Pietan pigs were submitted to a standardized gastric perforation procedure by aspiration and cutting, for which a polypectomy snare and an end adapter for endoscopic esophageal varices ligation were used. The omentum (OM) was pulled to the gastric cavity in most cases by aspiration with the endoscope) and then caught with the metallic snare and fixed to the muscular layer of the stomach by endoscopic metallic clips. By changing the position of the snare it was possible to place the clips in any convenient position. This procedure was carried out under general anesthesia. The animals received food on the first day after the operation. They were sacrificed on the 15th postoperative day. RESULTS - Nine animals had a normal postoperative course. In all of them, an ulcer could be seen at the repaired site. On the external side of the wall, the OM was adherent. No other alterations were observed in the peritoneal cavity. The gastric wall histology showed a moderate inflammatory process in these pigs. In one animal whose muscular layer could not be seen during the procedure, the clips attached the OM to the mucosa. This animal died on the 11th postoperative day. Examination of the peritoneal cavity at sacrifice revealed intense peritonitis. The perforation was not repaired in this animal. CONCLUSION - This seems to be a simple and easy technique for EGPR, as safe as the conventional surgery.With the use of antibiotics, the risk of infection could be considered acceptable, especially in view of the advantages offered by a less invasive procedure. It seems to be important to attach the omentum to the muscular layer. The EGPR with a patch of OM seems to be an interesting option to be confirmed by further studies.