Brief Article
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
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
Seung Uk Jeong, Hassanuddin Aizan, Tae Jun Song, Dong Wan Seo, Su-Hui Kim, Do Hyun Park, Sang Soo Lee, Sung Koo Lee, Myung-Hwan Kim
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.