Establishment of pure NOTES procedure using a conventional flexible endoscope: review of six cases of gastric gastrointestinal stromal tumors

TLDR

Hybrid NOTES has been increasingly reported, yet no studies have described how to perform a pure NOTES procedure using only a flexible endoscope. This study aimed to establish a pure NOTES technique for gastric GISTs. Six gastric GIST patients underwent hybrid NOTES, and each case was retrospectively reviewed to assess the suitability and effectiveness of ESD, double‑scope, spaced‑perforation, duodenal balloon occlusion, and loop‑clip methods. The results suggest that operative procedures exploiting flexible endoscope characteristics with conventional devices can advance the feasibility of pure NOTES.

Abstract

An increasing number of reports have recently been published on hybrid natural orifice transluminal endoscopic surgery (NOTES). These reports do not address how to complete an operation with a flexible endoscope alone (pure NOTES), but rather how to combine use of an endoscope and a laparoscope. Surgical procedures using flexible and rigid endoscopes have been developed using different processes and concepts. Recognizing this conceptual difference, we conducted a study to address how to establish a pure NOTES procedure. Six patients with gastric gastrointestinal stromal tumors (GISTs) underwent hybrid NOTES. Each case was retrospectively reviewed to determine the appropriateness of the treatment and the usefulness of the endoscopic submucosal dissection (ESD) method, double-scope method, spaced perforation method, duodenal balloon occlusion method, and loop clip technique. The development of operative procedures that take advantage of the characteristics of flexible endoscopes, even with conventional flexible endoscopic devices and conventional endoscopes alone, may contribute to the realization of pure NOTES.