Prospective Evaluation of NOTES (Natural Orifice Translumenal Endoscopic Surgery) PEG Rescue

Study Overview
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Brief Summary
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The purpose of this study is to determine: Utility of urgent upper endoscopy in setting of dislodges (percutaneous endoscopic gastrostomy) PEG tube. Feasibility of replacing naive PEG tubes with Natural Orifice Translumenal Endoscopic Surgery (NOTES) in lieu of traditional surgical methods. Efficacy of replacing naive PEG tubes with NOTES in lieu of traditional surgical methods.

Detailed Description
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Utility of Urgent Upper Endoscopy in Setting of Naïve Dislodged PEG Tubes as defined by: Percentage of Open vs. Closed Gastrotomy upon urgent endoscopy Presence of Incidental Pathology noted on Endoscopy Complications of Urgent Endoscopy Time of Procedure Technical Feasibility of the NOTES procedure determined by: Number of Successful/Failed PEG Placements Number of Patients Requiring intra-operative conversion to laparotomy or laparoscopic procedure Time to Complete Procedure Presence or absence of post-procedural contrast extravasation on completion contrast radiographic study Efficacy of NOTES PEG Rescue compared to historical controls as characterized by the following post-operative criteria: Number of Patients Requiring Subsequent Medical or Surgical Treatment for Intra-Abdominal Abscess Number of Patients Requiring Subsequent Medical or Surgical Wound Infection within 30 post-op days Post-Operative CT or Operative Findings consistent with abscess confirmed by culture positive drainage, aspiration Intra-Operative or Post-Operative Red Blood Cell Transfusion Length of Stay Antibiotics > 24h Post-Op 30 day Re-Admission Mortality

Official Title
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Prospective Evaluation of NOTES PEG Rescue

Conditions
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Malnutrition

Intervention / Treatment
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* Procedure: Natural Orifice Translumenal Endoscopic Surgery


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients must meet ALL of the following criteria For prospective candidates, an initial attempt to pass a balloon tipped foley catheter through the external cutaneous tract into the stomach will be performed. It will then be followed by radiographic contrast study to evaluate for extravasation of contrast into the peritoneal cavity. If contrast is extravasated, this will be potential candidate for inclusion. If the foley catheter is unable to be passed through the cutaneous tract, that will also be considered someone for inclusion as this patient will still require an operative confirmation of the patency of the gastrotomy. For retrospective candidates, intra-operative confirmation of dislodged tube as reported in the medical record. The patient must demonstrate pre-operative hemodynamic and respiratory stability No overwhelming medical co-morbidities prohibitive of surgery Subject is 18 years of age or older Subject or subject's legal decision-making proxy agrees to participate, fully understands and signs the informed consent form Exclusion Criteria: Patients must not meet ANY of the following criteria: Esophageal stricture prohibiting passage of an endoscope Any contraindication to surgery Pregnancy or actively breastfeeding women Evidence of active bowel obstruction Synchronous acute abdominal pathology warranting incision-based surgery

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 85 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: NOTES PEG Rescue<br>A new way of performing surgery is called Natural Orifice Translumenal Endoscopic Surgery, or NOTES, for short. NOTES may allow surgeons to perform abdominal surgery without any skin incisions. By using natural openings in the body, like the mouth, surgeons can enter the stomach with a tube instead of the traditional method of making an incision in the skin of the abdomen. | Procedure: Natural Orifice Translumenal Endoscopic Surgery<br>* Natural Orifice Translumenal Endoscopic Surgery (NOTES) procedures involve transmural passage of flexible endoscopes introduced via a natural orifice whereby permitting access to the peritoneal cavity while avoiding skin incisions. No clear indication due to a number of physiologic, microbiologic, immunologic, and technical limitations. The concept of NOTES PEG Rescue in the setting of a dislodged naïve PEG tube may spare individual patients the physiologic stress of traditional surgery while concomitantly providing a natural segue to further study the NOTES platform in the human setting. PEG Rescue may represent a unique, practical, and empowering application of the burgeoning experience of natural orifice translumenal endoscopic surgery.<br>* Other names: NOTES;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Participants With Successful Replacements of Dislodged PEG Tubes With NOTES Procedures in Lieu of Traditional Surgical Methods. | Successful replacement will be determined via the number of patients requiring conversion from NOTES PEG rescue to conventional incision-based surgery. | 30 day follow-up | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Dislodged PEG tube, NOTES