title: Hydroperitoneum-facilitated EUS-guided peritoneal entry and closure of alternate access sites for NOTES.
abstract: BACKGROUND
  Access sites other than the anterior gastric wall may provide improved ergonomics for natural orifice transluminal endoscopic surgery (NOTES). Endoscopic ultrasound (EUS) guidance significantly reduces, but does not eliminate, risk of access through these alternate sites. This study evaluates the utility of hydroperitoneum as an adjunct to EUS-guided access and closure of alternate access sites for NOTES.
  
  
  METHODS
  Access and closure procedures were initially performed with EUS guidance alone, and subsequently, because of complications resulting from this technique, the procedures were performed with the aid of a transabdominal hydroperitoneum.
  
  
  RESULTS
  In this nonrandomized study, 6 access and closure procedures performed with EUS guidance alone resulted in 4 complications. After modifying the technique to incorporate pre-access hydroperitoneum, 7 EUS-guided access and closure procedures were performed without significant complications.
  
  
  CONCLUSIONS
  Hydroperitoneum appears to be an effective adjunct to ensure the safety of EUS-guided peritoneal entry and closure of alternate access sites for NOTES.
authors.affiliation: Division of Gastroenterology, University of Michigan, Ann Arbor, MI 48109, USA. badihe@umich.edu
authors.forename: B Joseph
authors.initials: BJ
authors.lastname: Elmunzer
authors.forename: Amitabh
authors.initials: A
authors.lastname: Chak
authors.forename: Jason R
authors.initials: JR
authors.lastname: Taylor
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Trunzo
authors.forename: Cyrus R
authors.initials: CR
authors.lastname: Piraka
authors.forename: Steve J
authors.initials: SJ
authors.lastname: Schomisch
authors.forename: Gail M
authors.initials: GM
authors.lastname: Rising
authors.forename: Grace H
authors.initials: GH
authors.lastname: Elta
authors.forename: James M
authors.initials: JM
authors.lastname: Scheiman
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Ponsky
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Marks
authors.forename: Richard S
authors.initials: RS
authors.lastname: Kwon
mesh_terms: D000818:Animals; D019160:Endosonography; D005260:Female; D010535:Laparoscopy / Q000379:methods; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D023421:Models, Animal; D010537:Peritoneum / Q000601:surgery*; D013552:Swine; D014867:Water
chemical_list: D014867:Water