TY - JOUR
T1 - Infection during natural orifice transluminal endoscopic surgery
T2 - a randomized, controlled study in a live porcine model
AU - Giday, Samuel A.
AU - Dray, Xavier
AU - Magno, Priscilla
AU - Buscaglia, Jonathan M.
AU - Shin, Eun Ji
AU - Surti, Vihar C.
AU - Assumpcao, Lia
AU - Marohn, Michael R.
AU - Ruben, Dawn
AU - Zhigalin, Andrew
AU - Pipitone, Laurie J.
AU - Kantsevoy, Sergey V.
N1 - Funding Information:
Dr Dray thanks the French National Society for Gastroenterology (Société Nationale Française de Gastroentérologie, Robert Tournut Scholarship, 2006) and the American Gastroenterological Association Foundation for Digestive Health and Nutrition (Jon I. Isenberg International Scholar Award, 2007) for supporting his training and research in NOTES. The authors would like to thank Cook Endoscopy, Winston-Salem, North Carolina, for providing T bars free of charge for this study.
PY - 2010/4
Y1 - 2010/4
N2 - Background: Currently reported natural orifice transluminal endoscopic surgery (NOTES) procedures in animals have been done in heterogeneous milieus ranging from nonsterile to sterile procedures, with mixed results, including no infection in those performed in nonsterile settings. Objective: To establish the potential frequency of infection during NOTES, comparing sterile to nonsterile approaches. Setting: Survival experiments on sixteen 50-kg pigs. Design and Interventions: From pilot data (100% infection frequency after nonsterile procedures), sample size (8 animals in each group) was calculated by using a power of 95% and an alpha risk of 0.05. The animals were randomly assigned to two groups: In the transgastric peritoneoscopy study group, liver and ovarian biopsies were performed with sterile overtubes, endoscopes, and accessories and the use of preoperative intravenous antibiotics and antiseptic gastric lavage. In the nonsterile (control) group, the same procedures were performed with nonsterile endoscopes and accessories without the use of gastric lavage and preoperative antibiotics. Complete transmural closure of the transgastric access site was made in all animals. After a 1-week survival time, all animals were killed for necropsy, which included Gram staining and peritoneal cultures. Main Outcome Measurements: Intraperitoneal infection on necropsy. Results: All necropsies revealed intraperitoneal infection (abscesses, fibrinopurulent exudates, and adhesions) in the control group (frequency of infection 100%). Peritoneal bacterial culture grew various aerobic and anaerobic organisms. No gross or bacteriological evidence of infection was seen in the sterile group (frequency of infection 0%, P value = <.0002). Limitations: Animal experiments. Conclusion: Nonsterile conditions invariably lead to intraperitoneal infection. Aseptic techniques during NOTES can prevent intra-abdominal infection. Future studies will determine which infection prevention steps are mandatory and which can be omitted during NOTES procedures.
AB - Background: Currently reported natural orifice transluminal endoscopic surgery (NOTES) procedures in animals have been done in heterogeneous milieus ranging from nonsterile to sterile procedures, with mixed results, including no infection in those performed in nonsterile settings. Objective: To establish the potential frequency of infection during NOTES, comparing sterile to nonsterile approaches. Setting: Survival experiments on sixteen 50-kg pigs. Design and Interventions: From pilot data (100% infection frequency after nonsterile procedures), sample size (8 animals in each group) was calculated by using a power of 95% and an alpha risk of 0.05. The animals were randomly assigned to two groups: In the transgastric peritoneoscopy study group, liver and ovarian biopsies were performed with sterile overtubes, endoscopes, and accessories and the use of preoperative intravenous antibiotics and antiseptic gastric lavage. In the nonsterile (control) group, the same procedures were performed with nonsterile endoscopes and accessories without the use of gastric lavage and preoperative antibiotics. Complete transmural closure of the transgastric access site was made in all animals. After a 1-week survival time, all animals were killed for necropsy, which included Gram staining and peritoneal cultures. Main Outcome Measurements: Intraperitoneal infection on necropsy. Results: All necropsies revealed intraperitoneal infection (abscesses, fibrinopurulent exudates, and adhesions) in the control group (frequency of infection 100%). Peritoneal bacterial culture grew various aerobic and anaerobic organisms. No gross or bacteriological evidence of infection was seen in the sterile group (frequency of infection 0%, P value = <.0002). Limitations: Animal experiments. Conclusion: Nonsterile conditions invariably lead to intraperitoneal infection. Aseptic techniques during NOTES can prevent intra-abdominal infection. Future studies will determine which infection prevention steps are mandatory and which can be omitted during NOTES procedures.
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U2 - 10.1016/j.gie.2009.11.037
DO - 10.1016/j.gie.2009.11.037
M3 - Article
C2 - 20363423
AN - SCOPUS:77950197551
SN - 0016-5107
VL - 71
SP - 812
EP - 816
JO - Gastrointestinal endoscopy
JF - Gastrointestinal endoscopy
IS - 4
ER -