| Theme |
Future Perspectives of Therapeutic Endoscopy Such as ESD and NOTES |
| Title |
Bridging Technologies between NOTES and Intralumenal Endoscopic Interventions |
| Author |
Kazuki Sumiyama |
Department of Endoscopy, The Jikei University School of Medicine |
| Author |
Keiichi Ikeda |
Department of Endoscopy, The Jikei University School of Medicine |
| Author |
Hisao Tajiri |
Department of Endoscopy, The Jikei University School of Medicine / Department of Gastroenterology and Hepatology, The Jikei University School of Medicine |
| [ Summary ] |
The concept of natural orifice translumenal endoscopic surgery (NOTES) liberated endoscopy from the confines of the lumen. Moreover, it encouraged us to take the first step towards new frontiers beyond the gut wall via purposeful perforation. Pioneering clinical experiences have confirmed the supposed advantages of NOTES such as reduced pain and cosmesis over conventional laparoscopic surgeries. However, they also revealed technical challenges in performing intraperitoneal surgical procedures with a flexible endoscope without the assistance of percutaneously inserted rigid devices. The methods and technology developed from NOTES are now beginning to be utilized for various bridging technologies between NOTES and intralumenal endoscopic intervention. This technology may be employed not to aggressively access extralumenal organs distant from the gut wall but target the full thickness of the gut wall. Artificially created submucosal tunnels have been used for practical working spaces for endoscopic interventions. These provide a protective tunnel to access the submucosal regions as well as the muscularis, preventing peritoneal soiling by using the overlying mucosal layer as a sealant flap. Esophageal myotomy with the submucosal tunneling technique has enabled us to treat achalasia patients. A series of endoscopic bariatric interventions, some of which apply suturing and anastomosis technology to NOTES, have been developed as minimally invasive alternative to bariatric surgeries, which carry higher risks of critical complications. |