Endoscopic Technique Successfully Repairs Perforated Ulcers

A new study reports a 93% success rate in recent animal tests of natural orifice translumenal endoscopic surgery (NOTES) of perforated ulcers.

Researchers at the Mayo Clinic (Rochester, MN, USA) developed the technique, which involves the insertion of an endoscope with a suturing device into the stomach through the mouth to repair ulcers. The technique was tested in laboratory pigs, and the initial animal data suggests that the endoscopic approach necessitates less pressure than with conventional laparoscopic surgery, which could provide more cardiovascular stability for the patient. Among the other advantages mentioned by the researchers is the lack of surgical incisions, less discomfort for the patient when compared to laparoscopy (as 50% less air is introduced into the body), a shorter recovery time than in conventional surgery, and a potential ulcer-repair option for candidates too ill for conventional surgery. The researchers have received regulatory approval from the U.S. Food and Drug Administration (FDA) for using the NOTES repair in human volunteers, who will initially undergo general anesthesia and have the procedure performed in an operating room. The study was presented at the American College of Surgeons (ACS) 95th clinical congress, held during October 2009 in Chicago (IL, USA).

"Laparoscopic surgery for this condition is only 80% successful for a variety of reasons,” said senior author Juliane Bingener, M.D. "In our laboratory experiments we were over 90% successful. We also hope to ultimately reduce the risk to the patient overall and reduce postoperative complications.”

"In the future, if we can prove this technique works and have success with it, it can be done with less and less anesthesia, making the population that can undergo this procedure wider,” added study coauthor Erica Moran, M.D.

Perforated stomach ulcers typically require an operation to close the tear, but conventional open or minimally invasive surgical procedures can be problematic, particularly in seniors or younger patients with other health problems. The minimally invasive operation requires inflating the body cavity with carbon dioxide (CO2) to create a large enough workspace for manipulating the surgical probes. This process raises pressure in the peritoneum and abdominal cavity, concomitantly raising blood pressure, with obvious consequences for people with other health problems or older patients. Those same individuals are most vulnerable to problems with the more invasive open-cavity operation.

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