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01-04-2020 | Abdominal Compartment Syndrome

Intra-abdominal pressure during endoscopic full-thickness resection comparing manual and automatic control insufflation: a block-randomized porcine study

Authors: Shunsuke Kamba, Masakuni Kobayashi, Akio Koizumi, Shingo Ono, Yuko Hara, Nana Shimamoto, Hiroaki Matsui, Hiroto Furuhashi, Tomohiko Richard Ohya, Naoto Tamai, Masako Nishikawa, Kiyokazu Nakajima, Kazuki Sumiyama

Published in: Surgical Endoscopy | Issue 4/2020

Abstract

Background and study aims

An automatic carbon dioxide (CO₂) insufflating system (SPACE) was developed to stabilize intra-lumenal pressure (ILP) during endoscopic interventions. This study investigated whether SPACE could improve the control and monitoring of extra-lumenal intra-abdominal pressure (IAP) after establishing a perforation during endoscopic full-thickness resection (EFTR) of the gastric wall in porcine models.

Materials and methods

After first establishing the optimal preset pressure for gastric EFTR in four pigs, we compared IAP dynamics during EFTR between manual insufflation and SPACE using a block-randomized study (n = 10). IAP was percutaneously monitored and plotted on a timeline graph every 5 s. The maximal IAP and the area under the IAP curve exceeding 10 mmHg (AUC_≥10 mmHg) were compared between groups, with the agreement between IAP and endolumenally monitored ILP also analyzed for animals in the SPACE group.

Results

In the first study, 8 mmHg was identified as the most preferable preset pressure after establishment of the perforation. In the randomized study, the mean maximal IAP in the SPACE group was significantly lower than that in the manual insufflation group (11.0 ± 2.0 mmHg vs. 17.0 ± 3.5 mmHg; P = 0.03). The mean AUC_≥10 mmHg was also significantly smaller in the SPACE group. Bland–Altman analysis demonstrated agreement between IAP and ILP within a range of ± 1.0 mmHg.

Conclusions

SPACE could be used to control and safely monitor IAP during gastric EFTR by measuring ILP during perforation of the gastric wall.

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Title: Intra-abdominal pressure during endoscopic full-thickness resection comparing manual and automatic control insufflation: a block-randomized porcine study
Authors: Shunsuke Kamba
Masakuni Kobayashi
Akio Koizumi
Shingo Ono
Yuko Hara
Nana Shimamoto
Hiroaki Matsui
Hiroto Furuhashi
Tomohiko Richard Ohya
Naoto Tamai
Masako Nishikawa
Kiyokazu Nakajima
Kazuki Sumiyama
Publication date: 01-04-2020
Publisher: Springer US
Keyword: Abdominal Compartment Syndrome
Published in: Surgical Endoscopy / Issue 4/2020
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-019-06927-3

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Springer Medicine

Intra-abdominal pressure during endoscopic full-thickness resection comparing manual and automatic control insufflation: a block-randomized porcine study

Abstract

Background and study aims

Materials and methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background and study aims

Materials and methods

Results

Conclusions

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