ORIGINAL ARTICLE:Experimental Endoscopy Do gastrotomies require repair after endoscopic transgastric peritoneoscopy? A controlled study Simon Bergman, MD, MSc, Daniel J. Fix, BS, Kevin Volt, MD, Jason C. Roland, MD, Lynn Happel, MD Kevin M. Reavis, MD, Theodore J. Cios, BS, Vincent Ho, BS, Alan Evans BS, Vimal K. Narula, MD, Jeffrey W. Hazey, MD, W. Scott Melvin, MD Columbus, Ohio, USA Background: The optimalmethod forclosing gastrotomies after transgastric instrumentation has yet to be determined. Objective: To compare gastrotomy closure with endoscopically delivered bioabsorbable plugs with no clo Design: Prospective, controlled study. Setting: Animal laboratory. Subjects: Twenty-three dogs undergoing endoscopic transgastric peritoneoscopy between July and Augu Interventions: Endoscopic anterior wall gastrotomies were performed with balloon dilation to allow pas the endoscope into the peritoneal cavity. The plug group (n ⫽ 12) underwent endoscopic placement of a 4 6-cm bioabsorbable mesh plug in the perforation, whereas the no-treatment group (n ⫽ 11) did not. Animals underwent necropsy 2 weeks after the procedure. Main Outcome Measurements: Complications related to gastrotomy closure, gastric burst pressures, r ship of burst perforation to gastrotomy, and the degree of adhesions and inflammation at the gastrotomy Results: After the gastrotomy, all dogs survived without any complications. At necropsy, burst pressures 77 ⫽ 11 mm Hg and 76 ⫽ 15 mm Hg (P ⫽ .9) in the plug group and no-treatment group,respectively. Perforations occurred at the site of the gastrotomy in 2 of 12 animals in the plug group and in none of the in the no-treatment group (P ⫽ .5). Finally, there were minimal adhesions in all dogs (11/11) in the no-trea group and minimal adhesions in 3 and moderate adhesions or inflammatory masses in 9 of the 12 animals plug group (P ⫽ .004). Limitations: Smallnumberof subjects, animalmodel,no randomization. Gastrotomy trauma during short peritoneoscopy may not be applicable to longer procedures. Conclusions: After endoscopic gastrotomy, animals that were left untreated did not show any clinical ill and demonstrated adequate healing, with fewer adhesions and less inflammation compared with those tr with a bioabsorbable plug. ( Gastrointest Endosc 2010;71:1013-7.) The Natural Orifice Surgery Consortium for Assessment and Research, a Society of American Gastrointestinal and Endoscopic Surgeons/American Society for Gastrointest nal Endoscopy working group, identified gastric closure Abbreviations: NOTES, natural orifice transluminal endoscopic surgery; NTG, no-treatment group; PG, plug group. DISCLOSURE: The following authors disclosed financial relationships relevant to this publication: J.W. Hazey: Clinical advisory board member for Covidien. W.S. Melvin: Scientific advisory board member for Stryker, scientific advisory board member for Endogastric Solutions, scientific advisory board member for W.L. Gore.All other authors disclosed no financial relationships relevant to this publication Copyright © 2010 by the American Society for Gastrointestinal Endoscopy 0016-5107/$36.00 doi:10.1016/j.gie.2010.01.025 Received April 4, 2008. Accepted January 7, 2010. Current affiliations: Center for Minimally Invasive Surgery, Department Surgery, The Ohio State University, Columbus, Ohio, USA. This work was presented at the SAGES annual meeting, April 2008, Philadelphia, Pa. Reprint requests: W. Scott Melvin, MD, Division of General Surgery, Th Ohio State University, Room N729, Doan Hall, 410 West Tenth Avenue Columbus, OH 43210. www.giejournal.org Volume 71, No. 6 : 2010 GASTROINTESTINAL ENDOSCOPY 1013