Autopsy studies confirm that many intensive care unit patients die from unrecognized sources of abdominal sepsis or ischemia.
Computed tomography scans can be of limited use for these diagnoses.
These scans are difficult to obtain in critically ill patients who require significant support for transport.
Bedside laparoscopy has been described but still is cumbersome to perform.
In addition, bedside flexible endoscopy as a diagnostic tool or for placement of gastrostomy tubes is a standard intensive care unit procedure.
|The gallbladder was successfully drained percutaneously|
Natural orifice transluminal endoscopic surgery can provide access to the peritoneal cavity as a bedside procedure.
It may decrease the number of patients with unrecognized intra-abdominal catastrophic events.
Dr Raymond Onders and colleagues from Ohio evaluated these techniques in animal studies that included 8 pigs.
The research team obtained peritoneal access with the flexible endoscope using a guidewire, needle knife cautery, and balloon dilatation.
The team used the transgastric endoscope to explore all quadrants of the abdominal cavity.
The small bowel was visualized to complete the exploration.
The transgastric access location was then managed with the use of a gastrostomy tube.
The researchers reported that complete abdominal exploration, including diaphragm visualization, was possible in all cases.
The research team performed endoscopy-guided biopsies, and lysed adhesions.
In addition, the team successfully drained the gallbladder percutaneously.
The small bowel was run successfully with percutaneous needlescopic suture graspers.
Dr Onders' team concluded, “These animal studies support the concept that Natural orifice transluminal endoscopic surgery, with management of the gastric opening with a gastrostomy tube.”
“This may be another approach for finding unrecognized sources of abdominal sepsis or mesenteric ischemia in difficult intensive care unit patients.”
“The encouraging results warrant a prospective human trial to assess safety and efficacy.”