Biliary passage dilator assisted percutaneous endoscopic gastostomy in natural orifice translumenal endoscopic surgery

Abstract

Objective To explore the feasibility and safety of the biliary passage dilator assisted percutaneous endoscopic gastostomy（PEG）in natural orifice translumenal endoscopic surgery（NOTES）.Methods Eleven hybrid dogs were recruited to the study.One dog was used for pilot study of biliary passage dilator assisted PEG.The rest ten were divied into 2 groups randomly（5 per group）, receiving conventional PEG and biliary passage dilator assisted PEG, respectively.The efficacy and safety of these 2 methods in NOTES were compared.Two weeks later, routine gastroscopy was performed to detect the healing of luminal incision and all animals were sacrificed to explore the possible complications in the abdominal cavity.Results With the assistance of the biliary passage dilator, successful transgastric access to the peritoneal cavity was achieved in the pilot study.Biliary passage dilator assisted PEG was completed in all the 5 dogs of the experimetal group, while tradional PEG succeded in only 4.The average transgastric puncture time in the biliary passage dilator assisted PEG（7.0 ± 1.7 min）was significantly shorter than that of conventional PEG （11.0 ± 3.2 min, P 〈 0.05）.Nine dogs survived for 2 weeks postoperatively without loss of weight or peritonitis.Endoscopy showed transgastric puncture healed well.Autopsy revealed no gross adhering zone,bleeding, injury of adjacent organs or abcasses.Conclusion Compared with the conventional PEG, the biliary passage dilator assisted PEG shows the advantages of reduced difficulty and shoter time of puncture without any apparent complications.There is a good prospect of its application in NOTES. Key words: Endoscopic surgery; Transgastric puncture; Biliary passage dilator