Forward-viewing endoscopic ultrasound-guided NOTES interventions: a study on peritoneoscopic potential.

Area of Science:

• Gastroenterology and Endoscopy
• Minimally Invasive Surgery
• Medical Device Technology

Background:

• Natural orifice transluminal endoscopic surgery (NOTES) aims to reduce invasiveness.
• Forward-viewing endoscopic ultrasound (FV-EUS) offers advanced visualization and intervention capabilities.
• Transgastric (TG) peritoneoscopy is an emerging NOTES approach.

Purpose of the Study:

• To assess the feasibility of diagnostic and therapeutic transgastric (TG) peritoneoscopic interventions using FV-EUS.
• To evaluate the safety and efficacy of FV-EUS-guided procedures in an animal model.

Main Methods:

• A prospective experimental study was conducted on 10 animal models (1 porcine, 9 canine).
• Procedures included TG peritoneoscopy, EUS examination, endoscopic biopsy, EUS-guided fine needle aspiration (EUS-FNA), EUS-guided radiofrequency ablation (EUS-RFA), and argon plasma coagulation (APC).
• Animals were observed for 7 days post-procedure, followed by necropsy.

Main Results:

• Successful TG peritoneoscopy and endoscopic biopsies of the liver, spleen, abdominal wall, and omentum were achieved in all animals.
• Real-time EUS visualization of intra-abdominal organs was effective.
• EUS-FNA of the liver, spleen, and kidney, and EUS-RFA of the liver parenchyma were successful.
• APC effectively controlled minor bleeding, and no adverse events were recorded.

Conclusions:

• Transgastric peritoneoscopic NOTES interventions using FV-EUS are feasible for evaluation and endoscopic procedures.
• FV-EUS serves as a viable platform for future EUS-based NOTES interventions.
• This technique holds potential for minimally invasive intra-abdominal diagnostics and therapeutics.