Endoscopy 2011; 43(7): 631-634
DOI: 10.1055/s-0030-1256227
Case report/series

© Georg Thieme Verlag KG Stuttgart · New York

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

H.  Mori1 , H.  Kobara1 , M.  Kobayashi1 , A.  Muramatsu1 , T.  Nomura1 , M.  Hagiike2 , K.  Izuishi2 , Y.  Suzuki2 , T.  Masaki1
  • 1Department of Gastroenterology and Neurology, Kagawa Medical University School of Medicine, Kagawa, Japan
  • 2Department of Gastroenterological Surgery, Kagawa Medical University School of Medicine, Kagawa, Japan
Further Information

Publication History

submitted 12 November 2010

accepted after revision 7 December 2010

Publication Date:
24 May 2011 (online)

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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.