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Review of Pure Endoscopic Full-Thickness Resection of the Upper Gastrointestinal Tract.

Mori H, Kobara H, Nishiyama N, Fujihara S, Masaki T - Gut Liver (2015)

Bottom Line: It is expected that gastroenterological endoscopists will use this surgery if device development is advanced.This extremely minimally invasive surgery would have an immeasurable impact with regard to mitigating the burden on patients and reducing healthcare costs.Development of a new surgical method using a multi-purpose flexible endoscope is therefore considered a socially urgent issue.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology and Neurology, Kagawa University, Kita, Japan.

ABSTRACT
Natural-orifice transluminal endoscopic surgery (NOTES) using flexible endoscopy has attracted attention as a minimally invasive surgical method that does not cause an operative wound on the body surface. However, minimizing the number of devices involved in endoscopic, compared to laparoscopic, surgeries has remained a challenge, causing endoscopic surgeries to gradually be phased out of use. If a flexible endoscopic full-thickness suturing device and a counter-traction device were developed to expand the surgical field for gastrointestinal-tract collapse, then endoscopic full-thickness resection using NOTES, which is seen as an extension of endoscopic submucosal dissection for full-thickness excision of tumors involving the gastrointestinal-tract wall, might become an extremely minimally invasive surgical method that could be used to resect only full-thickness lesions approached by the shortest distance via the mouth. It is expected that gastroenterological endoscopists will use this surgery if device development is advanced. This extremely minimally invasive surgery would have an immeasurable impact with regard to mitigating the burden on patients and reducing healthcare costs. Development of a new surgical method using a multi-purpose flexible endoscope is therefore considered a socially urgent issue.

No MeSH data available.


Related in: MedlinePlus

(A, B) Comparison of logarithmic bacterial counts with and without saline irrigation before and after endoscopic submucosal dissection (ESD). The bacterial counts did not significantly differ between the regular group and the clean group before ESD (p=0.4). However, the difference in bacterial counts after ESD was significant between the regular group (without systemic irrigation) and the clean group (with systemic irrigation) (p=0.0004).
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f1-gnl-09-590: (A, B) Comparison of logarithmic bacterial counts with and without saline irrigation before and after endoscopic submucosal dissection (ESD). The bacterial counts did not significantly differ between the regular group and the clean group before ESD (p=0.4). However, the difference in bacterial counts after ESD was significant between the regular group (without systemic irrigation) and the clean group (with systemic irrigation) (p=0.0004).

Mentions: There were ethical problems in the above-mentioned mucosa exposure of 4% chlorhexidine and 10% povidone-iodine because their safety in human gastric mucosa was not established, despite the fact that risk has been noted. The present authors performed a prospective study on the effect of gastric lavage with 2 L of saline in the lumen on the reduction of total bacterial count and then evaluated the effect in a semi-closed system. Because the endoscope is inserted in the stomach via the oral cavity, exposure to oral bacteria is inevitable. Fifty patients diagnosed with early gastric cancer were divided into the clean group (25 patients) and the regular group (25 patients). The day before surgery, 30 mg of lansoprazole, a PPI, was administered once a day to both groups (all bacteria were cultured at 37°C for 48 hours). For bacterial culture in the stomach before gastric lavage, 20 mL of distilled water was sprinkled on the stomach wall before the initiation of ESD. Then, 20 mL of gastric juice was collected with a sterilized tube and submitted to a culture laboratory. Using an endoscope equipped with a water jet (GIF Q260J; Olympus, Tokyo, Japan), the stomach was irrigated with 2 L of saline throughout. After ESD was performed in the usual manner and resected tumors were collected, 20 mL of distilled water was sprinkled on the stomach wall. Then, 20 mL of gastric juice was collected with a sterilized tube and submitted to a culture laboratory. The opening of the forceps was sterilized with isodine, and the sterilized tube was inserted into the forceps before the tube was passed through the opening of the forceps. Fig. 1 shows the results of the effect on reducing the total bacterial count. We compared changes in the quantity of cultured bacteria for gastric juice in a logarithmic representation. In the regular group, the bacterial count of gastric juice before ESD had a median of 6.45 (95% confidence interval [CI], 4.93 to 7.32), and the bacterial count of gastric juice after ESD had a median of 5.62 (95% CI, 3.86 to 6.64); there was no significant difference before and after ESD. In the clean group, the bacterial count of gastric juice before gastric lavage had a median of 6.50 (95% CI, 3.88 to 8.11), and the bacterial count of gastric juice after ESD following gastric lavage had a median of 1.69 (95% CI, 0.84 to 3.68); the quantity of cultured bacteria for gastric juice was significantly reduced by gastric lavage with 2,000 mL of saline (p=0.0004).33 Based on these results, we examined laparoscopy and endoscopy cooperation surgery (LECS) in which the endoscope was exposed to the abdominal cavity. After the opening caused by full-thickness resection was sutured by hand, 20 mL of ascitic fluid was collected from the laparoscopic port and submitted to a culture laboratory. In addition, 20 mL of distilled water was sprinkled on the stomach wall. Subsequently, 20 mL of gastric juice was collected with a sterilized tube and submitted to a culture laboratory. The results demonstrate the effect on decreasing the total bacterial count for gastric juice after typical gastric lavage at the same level as ascitic fluid. For EFTR in the stomach, where gastric acid is present, it is thought that irrigation with saline may be more effective than disinfection with isodine, which may cause gastric mucosa injury. In 20 patients who underwent LECS, no postoperative infection was found after intravenous administration of antibiotics and irrigation of the upper gastrointestinal tract with 2 L of saline (Fig. 2).34 In conclusion, thorough intragastric irrigation with 2 L of saline or irrigation with saline combined with antibiotics provides a practical infection-control method by routing through the stomach, and this method can be introduced in clinical settings.


Review of Pure Endoscopic Full-Thickness Resection of the Upper Gastrointestinal Tract.

Mori H, Kobara H, Nishiyama N, Fujihara S, Masaki T - Gut Liver (2015)

(A, B) Comparison of logarithmic bacterial counts with and without saline irrigation before and after endoscopic submucosal dissection (ESD). The bacterial counts did not significantly differ between the regular group and the clean group before ESD (p=0.4). However, the difference in bacterial counts after ESD was significant between the regular group (without systemic irrigation) and the clean group (with systemic irrigation) (p=0.0004).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4562775&req=5

f1-gnl-09-590: (A, B) Comparison of logarithmic bacterial counts with and without saline irrigation before and after endoscopic submucosal dissection (ESD). The bacterial counts did not significantly differ between the regular group and the clean group before ESD (p=0.4). However, the difference in bacterial counts after ESD was significant between the regular group (without systemic irrigation) and the clean group (with systemic irrigation) (p=0.0004).
Mentions: There were ethical problems in the above-mentioned mucosa exposure of 4% chlorhexidine and 10% povidone-iodine because their safety in human gastric mucosa was not established, despite the fact that risk has been noted. The present authors performed a prospective study on the effect of gastric lavage with 2 L of saline in the lumen on the reduction of total bacterial count and then evaluated the effect in a semi-closed system. Because the endoscope is inserted in the stomach via the oral cavity, exposure to oral bacteria is inevitable. Fifty patients diagnosed with early gastric cancer were divided into the clean group (25 patients) and the regular group (25 patients). The day before surgery, 30 mg of lansoprazole, a PPI, was administered once a day to both groups (all bacteria were cultured at 37°C for 48 hours). For bacterial culture in the stomach before gastric lavage, 20 mL of distilled water was sprinkled on the stomach wall before the initiation of ESD. Then, 20 mL of gastric juice was collected with a sterilized tube and submitted to a culture laboratory. Using an endoscope equipped with a water jet (GIF Q260J; Olympus, Tokyo, Japan), the stomach was irrigated with 2 L of saline throughout. After ESD was performed in the usual manner and resected tumors were collected, 20 mL of distilled water was sprinkled on the stomach wall. Then, 20 mL of gastric juice was collected with a sterilized tube and submitted to a culture laboratory. The opening of the forceps was sterilized with isodine, and the sterilized tube was inserted into the forceps before the tube was passed through the opening of the forceps. Fig. 1 shows the results of the effect on reducing the total bacterial count. We compared changes in the quantity of cultured bacteria for gastric juice in a logarithmic representation. In the regular group, the bacterial count of gastric juice before ESD had a median of 6.45 (95% confidence interval [CI], 4.93 to 7.32), and the bacterial count of gastric juice after ESD had a median of 5.62 (95% CI, 3.86 to 6.64); there was no significant difference before and after ESD. In the clean group, the bacterial count of gastric juice before gastric lavage had a median of 6.50 (95% CI, 3.88 to 8.11), and the bacterial count of gastric juice after ESD following gastric lavage had a median of 1.69 (95% CI, 0.84 to 3.68); the quantity of cultured bacteria for gastric juice was significantly reduced by gastric lavage with 2,000 mL of saline (p=0.0004).33 Based on these results, we examined laparoscopy and endoscopy cooperation surgery (LECS) in which the endoscope was exposed to the abdominal cavity. After the opening caused by full-thickness resection was sutured by hand, 20 mL of ascitic fluid was collected from the laparoscopic port and submitted to a culture laboratory. In addition, 20 mL of distilled water was sprinkled on the stomach wall. Subsequently, 20 mL of gastric juice was collected with a sterilized tube and submitted to a culture laboratory. The results demonstrate the effect on decreasing the total bacterial count for gastric juice after typical gastric lavage at the same level as ascitic fluid. For EFTR in the stomach, where gastric acid is present, it is thought that irrigation with saline may be more effective than disinfection with isodine, which may cause gastric mucosa injury. In 20 patients who underwent LECS, no postoperative infection was found after intravenous administration of antibiotics and irrigation of the upper gastrointestinal tract with 2 L of saline (Fig. 2).34 In conclusion, thorough intragastric irrigation with 2 L of saline or irrigation with saline combined with antibiotics provides a practical infection-control method by routing through the stomach, and this method can be introduced in clinical settings.

Bottom Line: It is expected that gastroenterological endoscopists will use this surgery if device development is advanced.This extremely minimally invasive surgery would have an immeasurable impact with regard to mitigating the burden on patients and reducing healthcare costs.Development of a new surgical method using a multi-purpose flexible endoscope is therefore considered a socially urgent issue.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology and Neurology, Kagawa University, Kita, Japan.

ABSTRACT
Natural-orifice transluminal endoscopic surgery (NOTES) using flexible endoscopy has attracted attention as a minimally invasive surgical method that does not cause an operative wound on the body surface. However, minimizing the number of devices involved in endoscopic, compared to laparoscopic, surgeries has remained a challenge, causing endoscopic surgeries to gradually be phased out of use. If a flexible endoscopic full-thickness suturing device and a counter-traction device were developed to expand the surgical field for gastrointestinal-tract collapse, then endoscopic full-thickness resection using NOTES, which is seen as an extension of endoscopic submucosal dissection for full-thickness excision of tumors involving the gastrointestinal-tract wall, might become an extremely minimally invasive surgical method that could be used to resect only full-thickness lesions approached by the shortest distance via the mouth. It is expected that gastroenterological endoscopists will use this surgery if device development is advanced. This extremely minimally invasive surgery would have an immeasurable impact with regard to mitigating the burden on patients and reducing healthcare costs. Development of a new surgical method using a multi-purpose flexible endoscope is therefore considered a socially urgent issue.

No MeSH data available.


Related in: MedlinePlus