Objective To evaluate the feaibility and safety of gastrotomy in natural orifice transluminal endoscopic surgery(NOTES)using technique of percutaneous endoscopic gastostomy(PEG).Methods To retrospectively investigate and compare the success rate,complications and procedure time of gastrotomy in NOTES of dogs between PEG-like approach(PEG group,n =20)and needle knife incision(needle knife group,n =18).Results Gastrotomy was successfully performed in all animals.No mass bleeding or organ injury was observed in PEG group,while one dog in needle knife group encountered mass bleeding,and injuries to the adjacent organs were found in 3 others(0％ in PEG group vs.22％ in needle knife group,P ＜ 0.05).The procedure time of gastrotomy in PEG group was longer than that of needle knife group (15.0±3.7 min vs.6.0 ± 1.1 min,P ＜0.05).Conclusion Compared with the techniqued of needle knife incision,gastrotomy using PEG-like approach in NOTES is safe and feasible.

Objective To explore the feasibility and safety of the biliary passage dilator assisted percutaneous endoscopic gastostomy(PEG)in natural orifice translumenal endoscopic surgery(NOTES).Methods Eleven hybrid dogs were recruited to the study.One dog was used for pilot study of biliary passage dilator assisted PEG.The rest ten were divied into 2 groups randomly(5 per group), receiving conventional PEG and biliary passage dilator assisted PEG, respectively.The efficacy and safety of these 2 methods in NOTES were compared.Two weeks later, routine gastroscopy was performed to detect the healing of luminal incision and all animals were sacrificed to explore the possible complications in the abdominal cavity.Results With the assistance of the biliary passage dilator, successful transgastric access to the peritoneal cavity was achieved in the pilot study.Biliary passage dilator assisted PEG was completed in all the 5 dogs of the experimetal group, while tradional PEG succeded in only 4.The average transgastric puncture time in the biliary passage dilator assisted PEG(7.0 ± 1.7 min)was significantly shorter than that of conventional PEG (11.0 ± 3.2 min, P ＜ 0.05).Nine dogs survived for 2 weeks postoperatively without loss of weight or peritonitis.Endoscopy showed transgastric puncture healed well.Autopsy revealed no gross adhering zone,bleeding, injury of adjacent organs or abcasses.Conclusion Compared with the conventional PEG, the biliary passage dilator assisted PEG shows the advantages of reduced difficulty and shoter time of puncture without any apparent complications.There is a good prospect of its application in NOTES.