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Human applications of submucosal endoscopy under conscious sedation for pure natural orifice transluminal endoscopic surgery

Abstract

Background

The submucosal endoscopy provide not only a reliable methods of access and closure for peritoneoscopy, but also an endoscopic working space for full-thickness resection. The aim of this study was to report the clinical outcome of submucosal endoscopy for pure natural orifice transluminal endoscopic surgery.

Methods

We prospectively evaluated 10 patients who received submucosal endoscopies. The indications of submucosal endoscopy were transgastric peritoneoscopy (TGP) and endoscopic full-thickness resection (EFTR) of a gastric subepithelial tumor. All procedures were performed with a standard gastroscope under conscious sedation with the balanced propofol method in the endoscopic unit. After a 40 mm submucosal tunnel was created using an endoscopic submucosal dissection technique, (1) in TGP, balloon dilation of a serosal puncture and intraperitoneal exploration was performed; (2) in EFTR, a full-thickness incision and snaring resection was performed. Closure of the mucosal incision was performed by endoclips.

Results

All cases were technically feasible. The mean times for creating the submucosal tunnel, main procedure (peritoneal exploration or resection), and closure were acceptable (10.44 ± 2.42 minutes, 18.80 ± 9.41 minutes, and 5.63 ± 2.17 minutes, respectively). The mean hospital stay was 3.8 ± 1.48 days. All TGPs were diagnostic (4 peritoneal carcinomatosis and 1 tuberculosis). En bloc and complete resections were possible in all EFTRs (3 gastrointestinal stromal tumors and 2 schwannomas; mean tumor size, 20.8 ± 3.27 mm). There were no procedure-related complications, such as significant bleeding or peritonitis.

Conclusions

Human applications of submucosal endoscopy under conscious sedation for pure NOTES were feasible and safe.

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Acknowledgments

Supported in part by the Soonchunhyang University Research Fund.

Disclosures

Suck-Ho Lee, Sun-Joo Kim, Tae Hoon Lee, Il-Kwun Chung, Sang-Heum Park, Eun Ok Kim, Hyo Jin Lee, and Hyun Deuk Cho have no conflicts of interest or financial ties to disclose.

Author information

Correspondence to Sun-Joo Kim.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Video 1 Transgastric peritoneoscopy (WMV 5931 kb)

Video 2 Endoscopic full-thickness resection of subepithelial tumor (WMV 10253 kb)

Video 1 Transgastric peritoneoscopy (WMV 5931 kb)

Video 2 Endoscopic full-thickness resection of subepithelial tumor (WMV 10253 kb)

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Lee, S., Kim, S., Lee, T.H. et al. Human applications of submucosal endoscopy under conscious sedation for pure natural orifice transluminal endoscopic surgery. Surg Endosc 27, 3016–3020 (2013) doi:10.1007/s00464-013-2844-4

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Keywords

  • Conscious
  • Endoscopy
  • NOTES
  • Sedation
  • Submucosa