The impact of proton-pump inhibitors on intraperitoneal sepsis: A word of caution for transgastric NOTES procedures

Sonia L. Ramamoorthy, Jeffrey K. Lee, Yoav Mintz, John Cullen, Michelle K. Savu, David W. Easter, Alana Chock, Ravi Mittal, Santiago Horgan, Mark A. Talamini

Research output: Contribution to journalArticle

Abstract

Background: During transgastric natural orifice transluminal endoscopic surgery (NOTES), there is an iatrogenic perforation of the gastric wall with leakage of gastric contents into the peritoneal cavity. The aim of this study is to determine the effect of proton-pump inhibitors (PPI) and alterations of gastric pH on infection during transgastric surgery. Methods: Thirty 250-g male Sprague-Dawley rats were divided into a study group (SG, n = 15) and a control group (CG, n =15). SG were given 5 mg/kg pantoprazole for 3 days before procedure and another dose 1 h before. CG received saline at similar time points. A mini-laparotomy with gastrotomy was performed. Aspiration of 2.0 cc gastric contents was removed from the stomach and injected into the peritoneal cavity of both groups. Gastric pH and peritoneal pH levels were obtained. Gastric aspirate was sent for culture. White blood cell counts (WBC) were obtained on postoperative days 1, 7, and 14, and C-reactive protein (CRP) levels were obtained on postoperative day 1. At day 14, a necropsy was performed and aerobic and anaerobic cultures of the peritoneal cavity were obtained. Results: There were no deaths in either group. The average gastric pH in the SG was 5.13 versus 3.26 (p = 0.03) in the CG. The average peritoneal pH was similar in both groups. The WBC in the SG was 4.5 vs. 3.5 (1,000 cells/mm) in the CG. There was no elevation in CRP levels in either group. Bacterial cultures were positive in 3/15 (20%) rats in the CG and in 9/15 (60%) in the SG (p = 0.008). Intra-abdominal abscesses were found in 2/15 (13%) rats in the CG and in 5/15 (33%) in the SG (p = 0.08). Conclusions: Pretreatment with a PPI resulted in a higher rate of peritoneal bacterial contamination and abscess formation. The acidic environment of the stomach appears to be protective against infection when intraperitoneal contamination occurs as a result of gastrotomy.

Original languageEnglish (US)
Pages (from-to)16-20
Number of pages5
JournalSurgical Endoscopy and Other Interventional Techniques
Volume24
Issue number1
DOIs
StatePublished - Jan 2010
Externally publishedYes

Fingerprint

Natural Orifice Endoscopic Surgery
Proton Pump Inhibitors
Sepsis
Stomach
Peritoneal Cavity
Gastrointestinal Contents
Leukocyte Count
C-Reactive Protein
Abdominal Abscess
Infection
Laparotomy
Abscess
Sprague Dawley Rats
Control Groups

Keywords

  • Natural orifice surgery
  • NOTES
  • Proton-pump inhibitors
  • Transgastric surgery

ASJC Scopus subject areas

  • Surgery

Cite this

The impact of proton-pump inhibitors on intraperitoneal sepsis : A word of caution for transgastric NOTES procedures. / Ramamoorthy, Sonia L.; Lee, Jeffrey K.; Mintz, Yoav; Cullen, John; Savu, Michelle K.; Easter, David W.; Chock, Alana; Mittal, Ravi; Horgan, Santiago; Talamini, Mark A.

In: Surgical Endoscopy and Other Interventional Techniques, Vol. 24, No. 1, 01.2010, p. 16-20.

Research output: Contribution to journalArticle

Ramamoorthy, SL, Lee, JK, Mintz, Y, Cullen, J, Savu, MK, Easter, DW, Chock, A, Mittal, R, Horgan, S & Talamini, MA 2010, 'The impact of proton-pump inhibitors on intraperitoneal sepsis: A word of caution for transgastric NOTES procedures', Surgical Endoscopy and Other Interventional Techniques, vol. 24, no. 1, pp. 16-20. https://doi.org/10.1007/s00464-009-0559-3
Ramamoorthy, Sonia L. ; Lee, Jeffrey K. ; Mintz, Yoav ; Cullen, John ; Savu, Michelle K. ; Easter, David W. ; Chock, Alana ; Mittal, Ravi ; Horgan, Santiago ; Talamini, Mark A. / The impact of proton-pump inhibitors on intraperitoneal sepsis : A word of caution for transgastric NOTES procedures. In: Surgical Endoscopy and Other Interventional Techniques. 2010 ; Vol. 24, No. 1. pp. 16-20.
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abstract = "Background: During transgastric natural orifice transluminal endoscopic surgery (NOTES), there is an iatrogenic perforation of the gastric wall with leakage of gastric contents into the peritoneal cavity. The aim of this study is to determine the effect of proton-pump inhibitors (PPI) and alterations of gastric pH on infection during transgastric surgery. Methods: Thirty 250-g male Sprague-Dawley rats were divided into a study group (SG, n = 15) and a control group (CG, n =15). SG were given 5 mg/kg pantoprazole for 3 days before procedure and another dose 1 h before. CG received saline at similar time points. A mini-laparotomy with gastrotomy was performed. Aspiration of 2.0 cc gastric contents was removed from the stomach and injected into the peritoneal cavity of both groups. Gastric pH and peritoneal pH levels were obtained. Gastric aspirate was sent for culture. White blood cell counts (WBC) were obtained on postoperative days 1, 7, and 14, and C-reactive protein (CRP) levels were obtained on postoperative day 1. At day 14, a necropsy was performed and aerobic and anaerobic cultures of the peritoneal cavity were obtained. Results: There were no deaths in either group. The average gastric pH in the SG was 5.13 versus 3.26 (p = 0.03) in the CG. The average peritoneal pH was similar in both groups. The WBC in the SG was 4.5 vs. 3.5 (1,000 cells/mm) in the CG. There was no elevation in CRP levels in either group. Bacterial cultures were positive in 3/15 (20{\%}) rats in the CG and in 9/15 (60{\%}) in the SG (p = 0.008). Intra-abdominal abscesses were found in 2/15 (13{\%}) rats in the CG and in 5/15 (33{\%}) in the SG (p = 0.08). Conclusions: Pretreatment with a PPI resulted in a higher rate of peritoneal bacterial contamination and abscess formation. The acidic environment of the stomach appears to be protective against infection when intraperitoneal contamination occurs as a result of gastrotomy.",
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T2 - A word of caution for transgastric NOTES procedures

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AU - Lee, Jeffrey K.

AU - Mintz, Yoav

AU - Cullen, John

AU - Savu, Michelle K.

AU - Easter, David W.

AU - Chock, Alana

AU - Mittal, Ravi

AU - Horgan, Santiago

AU - Talamini, Mark A.

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N2 - Background: During transgastric natural orifice transluminal endoscopic surgery (NOTES), there is an iatrogenic perforation of the gastric wall with leakage of gastric contents into the peritoneal cavity. The aim of this study is to determine the effect of proton-pump inhibitors (PPI) and alterations of gastric pH on infection during transgastric surgery. Methods: Thirty 250-g male Sprague-Dawley rats were divided into a study group (SG, n = 15) and a control group (CG, n =15). SG were given 5 mg/kg pantoprazole for 3 days before procedure and another dose 1 h before. CG received saline at similar time points. A mini-laparotomy with gastrotomy was performed. Aspiration of 2.0 cc gastric contents was removed from the stomach and injected into the peritoneal cavity of both groups. Gastric pH and peritoneal pH levels were obtained. Gastric aspirate was sent for culture. White blood cell counts (WBC) were obtained on postoperative days 1, 7, and 14, and C-reactive protein (CRP) levels were obtained on postoperative day 1. At day 14, a necropsy was performed and aerobic and anaerobic cultures of the peritoneal cavity were obtained. Results: There were no deaths in either group. The average gastric pH in the SG was 5.13 versus 3.26 (p = 0.03) in the CG. The average peritoneal pH was similar in both groups. The WBC in the SG was 4.5 vs. 3.5 (1,000 cells/mm) in the CG. There was no elevation in CRP levels in either group. Bacterial cultures were positive in 3/15 (20%) rats in the CG and in 9/15 (60%) in the SG (p = 0.008). Intra-abdominal abscesses were found in 2/15 (13%) rats in the CG and in 5/15 (33%) in the SG (p = 0.08). Conclusions: Pretreatment with a PPI resulted in a higher rate of peritoneal bacterial contamination and abscess formation. The acidic environment of the stomach appears to be protective against infection when intraperitoneal contamination occurs as a result of gastrotomy.

AB - Background: During transgastric natural orifice transluminal endoscopic surgery (NOTES), there is an iatrogenic perforation of the gastric wall with leakage of gastric contents into the peritoneal cavity. The aim of this study is to determine the effect of proton-pump inhibitors (PPI) and alterations of gastric pH on infection during transgastric surgery. Methods: Thirty 250-g male Sprague-Dawley rats were divided into a study group (SG, n = 15) and a control group (CG, n =15). SG were given 5 mg/kg pantoprazole for 3 days before procedure and another dose 1 h before. CG received saline at similar time points. A mini-laparotomy with gastrotomy was performed. Aspiration of 2.0 cc gastric contents was removed from the stomach and injected into the peritoneal cavity of both groups. Gastric pH and peritoneal pH levels were obtained. Gastric aspirate was sent for culture. White blood cell counts (WBC) were obtained on postoperative days 1, 7, and 14, and C-reactive protein (CRP) levels were obtained on postoperative day 1. At day 14, a necropsy was performed and aerobic and anaerobic cultures of the peritoneal cavity were obtained. Results: There were no deaths in either group. The average gastric pH in the SG was 5.13 versus 3.26 (p = 0.03) in the CG. The average peritoneal pH was similar in both groups. The WBC in the SG was 4.5 vs. 3.5 (1,000 cells/mm) in the CG. There was no elevation in CRP levels in either group. Bacterial cultures were positive in 3/15 (20%) rats in the CG and in 9/15 (60%) in the SG (p = 0.008). Intra-abdominal abscesses were found in 2/15 (13%) rats in the CG and in 5/15 (33%) in the SG (p = 0.08). Conclusions: Pretreatment with a PPI resulted in a higher rate of peritoneal bacterial contamination and abscess formation. The acidic environment of the stomach appears to be protective against infection when intraperitoneal contamination occurs as a result of gastrotomy.

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