Brief Article
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World J Gastroenterol. Nov 7, 2013; 19(41): 7160-7167
Published online Nov 7, 2013. doi: 10.3748/wjg.v19.i41.7160
Forward-viewing endoscopic ultrasound-guided NOTES interventions: A study on peritoneoscopic potential
Myung-Hwan Kim, Sung Koo Lee, Sang Soo Lee, Do Hyun Park, Su-Hui Kim, Dong Wan Seo, Tae Jun Song, Hassanuddin Aizan, Seung Uk Jeong
Seung Uk Jeong, Hassanuddin Aizan, Dong Wan Seo, Do Hyun Park, Sang Soo Lee, Sung Koo Lee, Myung-Hwan Kim, Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, South Korea
Tae Jun Song, Department of Internal Medicine, Ilsan Paik Hospital, Inje University, Koyang 411-706, South Korea
Su-Hui Kim, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, South Korea
Author contributions: Jeong SU and Aizan H contributed equally to this work; Jeong SU, Aizan H, Song TJ and Seo DW designed the research; Jeong SU, Aizan H, Song TJ, Seo DW and Kim SH performed the research; Park DH, Lee SS, Lee SK and Kim MH contributed new reagents/analytic tools; Jeong SU, Aizan H and Song TJ analyzed the data; Jeong SU and Aizan H wrote the paper.
Correspondence to: Dong Wan Seo, MD, PhD, Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-gil, Songpa-Gu, Seoul 138-736, South Korea. dwseoamc@amc.seoul.kr
Telephone: +82-2-30103192 Fax: +82-2-4760824
Received: June 5, 2013
Revised: August 19, 2013
Accepted: September 15, 2013
Published online: November 7, 2013
Processing time: 164 Days and 21.1 Hours
Abstract

AIM: To evaluate the feasibility of diagnostic and therapeutic transgastric (TG) peritoneoscopic interventions with a forward-viewing endoscopic ultrasound (FV-EUS).

METHODS: This prospective endoscopic experimental study used an animal model. Combined TG peritoneoscopic interventions and EUS examination of the intra-abdominal organs were performed using an FV-EUS on 10 animal models (1 porcine and 9 canine). The procedures carried out include EUS evaluation and endoscopic biopsy of intraperitoneal organs, EUS-guided fine needle aspiration (EUS-FNA), EUS-guided radiofrequency ablation (EUS-RFA), and argon plasma coagulation (APC) for hemostatic control. The animals were kept alive for 7 d, and then necropsy was performed to evaluate results and complications.

RESULTS: In all 10 animals, TG peritoneoscopy, followed by endoscopic biopsy for the liver, spleen, abdominal wall, and omentum, was performed successfully. APC helped control minor bleeding. Visualization of intra-abdominal solid organs with real-time EUS was accomplished with ease. Intraperitoneal EUS-FNA was successfully performed on the liver, spleen, and kidney. Similarly, a successful outcome was achieved with EUS-RFA of the hepatic parenchyma. No adverse events were recorded during the study.

CONCLUSION: Peritoneoscopic natural orifice transluminal endoscopic surgery (NOTES) interventions through FV-EUS were feasible in providing evaluation and performing endoscopic procedures. It promises potential as a platform for future EUS-based NOTES.

Keywords: Forward-viewing endoscopic ultrasound; Oblique-viewing endoscopic ultrasound; Endoscopic ultrasound guided intervention; Peritoneoscopy; Natural orifice transluminal endoscopic surgery

Core tip: Recently, the forward-viewing endoscopic ultrasound (FV-EUS) was developed, however, peritoneoscopic natural orifice transluminal endoscopic surgery (NOTES) interventions with an FV-EUS has never been discussed. In this study, transgastric peritoneoscopy with FV-EUS, real-time EUS, EUS-guided fine needle aspiration, EUS-guided radiofrequency ablation, and bleeding control were successfully undertaken. FV-EUS will broaden the prospects of NOTES interventions to endoscopists, and the NOTES interventions with an FV-EUS might be performed in the various conditions.