title: Feasibility study of EUS-NOTES as a novel approach for pancreatic cancer staging and therapy: an international collaborative study.
abstract: OBJECTIVE
  EUS guided Natural Orifice Transluminal Endoscopic Surgery (NOTES) could be a potentially viable approach for pancreatic surgery. EUS-guided access through the stomach wall may prove to be a safe and effective method for accessing the pancreas. The aim of the study was to assess the EUS-guided diagnostic and therapeutic procedures during NOTES for both anterior and posterior approach of the pancreas.
  
  
  METHODS
  The feasibility of peritoneoscopy through an anterior EUS-guided transgastric approach, as well as direct access to the pancreas through a posterior EUS-guided transgastric approach was tested for ease of access to the tail of the pancreas. Gastric wound closure was finally performed in several animals using various commercial and prototype endoscopic accessories.
  
  
  RESULTS
  The results showed the ability of EUS-NOTES technology to facilitate a transgastric approach and provide both an anterior and posterior access the pancreas. Identification the pancreatic tail by EUS with the aid of EUS-guided T-tag insertion, as well as posterior access and subsequent inspection/dissection of the pancreatic tail may also be possible.
  
  
  CONCLUSIONS
  It is technically possible by EUS-guided NOTES procedures to achieve a systematic anterior and posterior access for NOTES transgastric peritoneoscopy and direct pancreatic endoscopic procedures.
authors: Department of Gastroenterology, University of Texas MD Anderson Cancer Center, Houston, TX 77030-4009, USA.
authors: Adrian
authors: A
authors: Saftoiu
authors: Manoop S
authors: MS
authors: Bhutani
authors: Peter
authors: P
authors: Vilmann
authors: Valeriu
authors: V
authors: Surlin
authors: Rajesh K
authors: RK
authors: Uthamanthil
authors: Jeffrey H
authors: JH
authors: Lee
authors: Mehmet
authors: M
authors: Bektas
authors: Harvinder
authors: H
authors: Singh
authors: Dan
authors: D
authors: lonut
authors: Gheonea
authors: Stefan
authors: S
authors: Pactrascu
authors: Vikas
authors: V
authors: Gupta
authors: Matthew H
authors: MH
authors: Katz
authors: Jason B
authors: JB
authors: Fleming
mesh_terms: D000818:Animals; D004724:Endoscopy; D019160:Endosonography / Q000379:methods*; D005240:Feasibility Studies; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D013552:Swine