Portal de Periódicos da CAPES

Peroral transgastric endoscopic ligation of fallopian tubes with long-term survival in a porcine model

2005; Elsevier BV; Volume: 62; Issue: 3 Linguagem: Inglês

10.1016/s0016-5107(05)01637-8

1097-6779

Philip Wai Yan Chiu, Wilfred Lik‐Man Mui, Wing‐Tai Siu, Enders K. Ng,

Gastrointestinal Tumor Research and Treatment

To the Editor:We appreciated the marvelous results achieved by the Johns Hopkins University and the APOLLO Group in the development of transgastric endoscopic surgery. In the current article, Jagannath et al1Jagannath S.B. Kantsevoy S.V. Vaughn C.A. Chung S.C. Cotton P.B. Gostout C. et al.Peroral transgastric endoscopic ligation of fallopian tubes with long-term survival in a porcine model.Gastrointest Endosc. 2005; 61: 449-453Abstract Full Text Full Text PDF PubMed Scopus (365) Google Scholar reported their experiences on transgastric endoscopic ligation of fallopian tubes in a porcine model. The investigators gained access to the peritoneal cavity via an incision through the gastric wall with a cutting-wire needle knife. The incision subsequently was dilated with a radial expansion balloon up to 20 mm. After the procedure, the gastrotomy was allowed to close spontaneously. The investigators commented that a suture or the approximation of the gastric wall was unnecessary because the “entry site” will close immediately. As a surgeon, we have reservations on leaving the transgastric entry site unclosed if this approach is adopted in human beings in the future.Previously, we conducted a prospective randomized trial that compared nonoperative against operative treatment for perforated peptic ulcers.2Crofts T.J. Park K.C. Steele R.J. Chung S.C.S. Li A.K.C. A randomized trial of nonoperative treatment for perforated peptic ulcer.N Engl J Med. 1989; 320: 970-973Crossref PubMed Scopus (210) Google Scholar Although either approach resulted in similar mortality and morbidity rates, those who received nonoperative treatment had a significantly longer hospital stay. Of the patients, 27.5% subsequently required operative repair upon failed nonoperative treatment. Similar figures were reported in other series.3The editors of Lancet Conservative management of perforated peptic ulcer.Lancet. 1989; II: 1429-1430Google Scholar Currently, EMR has been widely performed as a curative treatment for early gastric cancer. Ono et al4Ono H. Kondo H. Gotoda T. Shirao K. Yamaguchi H. Saito D. et al.Endoscopic mucosal resection for treatment of early gastric cancer.GUT. 2001; 48: 225-229Crossref PubMed Scopus (1358) Google Scholar reported a perforation rate of 5% during EMR, of which most were managed successfully by closure of the defect with hemoclips. These clinical scenarios simulated the settings of transgastric surgery when we are dealing with abnormal tissue that might not heal by second intention. We believe that closure of the gastric “entry site” is much safer than leaving it to nature when transgastric surgery is performed in human beings. To the Editor: We appreciated the marvelous results achieved by the Johns Hopkins University and the APOLLO Group in the development of transgastric endoscopic surgery. In the current article, Jagannath et al1Jagannath S.B. Kantsevoy S.V. Vaughn C.A. Chung S.C. Cotton P.B. Gostout C. et al.Peroral transgastric endoscopic ligation of fallopian tubes with long-term survival in a porcine model.Gastrointest Endosc. 2005; 61: 449-453Abstract Full Text Full Text PDF PubMed Scopus (365) Google Scholar reported their experiences on transgastric endoscopic ligation of fallopian tubes in a porcine model. The investigators gained access to the peritoneal cavity via an incision through the gastric wall with a cutting-wire needle knife. The incision subsequently was dilated with a radial expansion balloon up to 20 mm. After the procedure, the gastrotomy was allowed to close spontaneously. The investigators commented that a suture or the approximation of the gastric wall was unnecessary because the “entry site” will close immediately. As a surgeon, we have reservations on leaving the transgastric entry site unclosed if this approach is adopted in human beings in the future. Previously, we conducted a prospective randomized trial that compared nonoperative against operative treatment for perforated peptic ulcers.2Crofts T.J. Park K.C. Steele R.J. Chung S.C.S. Li A.K.C. A randomized trial of nonoperative treatment for perforated peptic ulcer.N Engl J Med. 1989; 320: 970-973Crossref PubMed Scopus (210) Google Scholar Although either approach resulted in similar mortality and morbidity rates, those who received nonoperative treatment had a significantly longer hospital stay. Of the patients, 27.5% subsequently required operative repair upon failed nonoperative treatment. Similar figures were reported in other series.3The editors of Lancet Conservative management of perforated peptic ulcer.Lancet. 1989; II: 1429-1430Google Scholar Currently, EMR has been widely performed as a curative treatment for early gastric cancer. Ono et al4Ono H. Kondo H. Gotoda T. Shirao K. Yamaguchi H. Saito D. et al.Endoscopic mucosal resection for treatment of early gastric cancer.GUT. 2001; 48: 225-229Crossref PubMed Scopus (1358) Google Scholar reported a perforation rate of 5% during EMR, of which most were managed successfully by closure of the defect with hemoclips. These clinical scenarios simulated the settings of transgastric surgery when we are dealing with abnormal tissue that might not heal by second intention. We believe that closure of the gastric “entry site” is much safer than leaving it to nature when transgastric surgery is performed in human beings. Peroral transgastric endoscopic ligation of fallopian tubes with long-term survival in a porcine modelGastrointestinal EndoscopyVol. 61Issue 3PreviewWe have previously reported the feasibility and safety of the peroral transgastric endoscopic approach for diagnostic peritoneoscopy, liver biopsy, and gastrojejunostomy with long-term survival in a porcine model. This approach eliminates incisions of the abdominal wall, providing a less invasive alternative to diagnostic and therapeutic laparoscopy. We now report successful performance of peroral endoscopic transgastric ligation of Fallopian tubes with long-term survival in a porcine model. Full-Text PDF Response:Gastrointestinal EndoscopyVol. 62Issue 3PreviewWe thank Dr. Chiu for his interest in our study.1 In his letter, Dr. Chiu states his belief that closure of the gastric incision will be necessary in human beings who undergo transgastric endoscopic procedures. As clinical trials progress in this arena, this issue is but one of many questions that need to be addressed and resolved. Full-Text PDF