Feasibility of Translumenal Endoscopic Omental Patch Closure of Perforated Viscus

Not Applicable

Completed

Brief Summary: This study is being done to see if a new approach to repair perforated ulcers in the stomach (holes in the stomach) or the first part of the intestine is possible. Traditionally, either open operations (large single incision) or laparoscopic operations (multiple small camera-guided incisions) have been used to repair perforated ulcers. Over the last ten years, some surgeons have used endoscopic equipment to assist them with performing the procedure. It is unknown if perforated ulcer repair can be done using an endoscope as the main instrument (a flexible tube with a video camera inserted into the stomach through your esophagus) to "patch" or plug the perforation. We will patch the perforation using a standard method which uses tissue from outside the stomach. A laparoscopic camera will also be used to assist our view. This study is intended to be a feasibility study to demonstrate the endoscopic technique can be safely performed

Hypothesis: The primary outcome is successful completion of the procedure.

Detailed Description: Perforation is the most dangerous complication of gastroduodenal ulcer disease. It accounts for more than 70% of deaths associated with peptic ulcer disease. In addition to age and concomitant disease, intervention related complications are statistically significant predictors of death after hospital stay. Age, time to presentation and comorbidities are not factors that can be influenced. If it would be possible to reduce the impact of procedure related complications or the "second hit", that may lead to decreased morbidity and mortality.

This will be a pilot clinical study to evaluate the safety and feasibility of endoscopic translumenal omental patch closure. Patients with the clinical diagnosis of a perforated viscus who are scheduled to undergo surgical exploration will be recruited. Endoscopic translumenal omental patch will be attempted first if the patient has no contraindication. Should this prove unsuccessful, the surgical team will proceed with conversion to laparoscopic or open standard surgical therapy as indicated.

Recruitment & Eligibility

Inclusion Criteria

Patients presenting with clinical diagnosis of a perforated viscus who are scheduled to undergo surgical intervention
Surgical candidate for endoscopic, laparoscopic, or open procedure
Age > 21
Informed written consent

Exclusion Criteria

Prior gastric or duodenal surgery
Prior total abdominal colectomy or transverse colectomy
Prior omentectomy or omental flaps
Known perforation site other than stomach or duodenum
Patients with contra-indications for laparoscopy
Patients with contraindications for endoscopy
Upper gastrointestinal anatomy that would preclude endoscopic therapy
Coagulopathy or thrombocytopenia
Pregnant patients
Patients <21 years of age
Prisoners
Patients found at surgery to have disease processes other than perforated peptic ulcer disease will be asked for permission to record their data for comparison

Arm && Interventions

Group	Intervention	Description
Endoscopic Translumenal Omental Patch	Endoscopic Translumenal Omental Patch	Patients with the clinical diagnosis of a perforated viscus who are scheduled to undergo surgical exploration will be recruited. The endoscope will be gently advanced through the ulcer. Irrigation with saline will proceed. Then a viable mobile piece of omentum will be identified and pulled into the ulcer. After the omentum is located in the stomach, clips will be used to fix the Endoscopic Translumenal Omental Patch in place.

Primary Outcome Measures

Name	Time	Method
Number of Participants Completing Natural Orifice Translumenal Endoscopic Surgical (NOTES) Repair	2 days post-operation	At the time of surgery the repair was pressure tested using endoscopic insufflation. Two days post-operation all participants receiving the NOTES repair underwent a water-soluble contrast study to demonstrate leakage. Note: The NOTES procedure was attempted first if the subject had no contraindication. If this proved unsuccessful the surgical team proceeded with conversion to laparoscopic or open standard surgical therapy as indicated.

Secondary Outcome Measures

Name	Time	Method

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