World Congress of Gastroenterology

WCOG 2019


 
EXPERIMENTAL RESEARCH ON EXTERNAL MAGNETIC ASSISTED GASTROSCOPY FOR TRANSGASTRIC AND ABDOMINAL EXPLORATION BIOPSY
DAKE CHU 1 ZIXI ZHANG 1 JUN ZHANG 1 YUN WANG 1

1- XIAN JIAOTONG UNIVERSITY
 
Background/Aims:

Intraperitoneal exploration via natural endoscopy (NOTES) via gastric approach is a new concept of digestive endoscopy technology. It is found that after the soft endoscope penetrates the gastric wall into the abdominal cavity, it is not only difficult to effectively pull and move the exposure field of tissues and organs, but also unable to effectively explore the left upper quadrant, and other quadrants can not achieve the purpose of multi-angle exploration. To this end, we designed an external control permanent magnet and a magnetic ring to explore the effect of external magnetic assistance anchoring the soft endoscope body behind the abdominal wall on abdominal exploration and biopsy.

Materials and Methods:

A female pig model was used. First, the serosa layer was incised near the anterior gastric wall and antrum through a tunnel through the oral route with a needle knife, and the passage was enlarged with an expanding balloon. The ordinary gastroscope or the gastroscope with a mirror body magnetic ring were put into the abdominal cavity. Under the video system, ordinary gastroscopes try to explore the quadrants of the abdominal cavity through the depth and angle adjustment of the mirror body, and try to find the gallbladder, fallopian tube and appendix. Magnetically assisted gastroscopy (MAG) anchors magnetic rings to each quadrant by external magnets, and attempts to expose gallbladder, fallopian tube and appendix by pulling and moving tissues and organs.

Results:

There was no obvious bleeding in gastroscopy and magnetic ring endoscopy through balloon enlarged incision. General gastroscopy has a long operation time in the exploration of abdominal cavity, and failed to complete the exploration of spleen and left upper quadrant. It is difficult to pull and move the omentum. Although common gastroscopy can realize the exploration of gallbladder and fallopian tube, it is difficult to operate and takes a long time. Moreover, it is difficult to move tissues and organs in the exploration of appendix. With in vitro magnetic assistance, because the mirror body is anchored to the abdominal wall to provide a support point and moves with the magnet in vitro, endoscopy can effectively explore the abdominal cavity of each quadrant including the spleen from multiple angles, and the operation time is significantly shortened. In the exploration of gallbladder, fallopian tube and appendix, magnetic assistance is relatively easy to operate, the time is shortened, and the visual field of each organ is well exposed. No obvious abdominal wall tissue and abdominal viscera injury were found during laparotomy.

Conclusion:

Extracorporeal magnetic-assisted transperitoneal endoscopy biopsy is more extensive, less difficult to operate, better visual field exposure and no additional injury than conventional gastroscopy on intraperitoneal exploration.

Keywords:

NOTES, external magnetic assistance, intraperitoneal exploration, gastroscopy