title: Minimally invasive autopsy by using postmortem endoluminal and transluminal endoscopy and EUS.
abstract: BACKGROUND
  Virtual autopsy by using CT imaging has been introduced as an alternative to conventional autopsy and has resulted in an increase in acceptance of autopsy by relatives. Because direct inspection and tissue acquisition is not possible by imaging alone, various endoscopic techniques can be considered of complementary usefulness.
  
  
  OBJECTIVE
  We present the first series of sequential endoscopic techniques including natural orifice transluminal access for minimally invasive autopsy.
  
  
  METHODS
  University hospital, legal medicine department.
  
  
  METHODS
  Twenty deceased subjects.
  
  
  METHODS
  Various flexible endoscopic modalities including EUS, with biopsy or EUS-guided FNA, were attempted. This included transluminal intra-abdominal endoscopic exploration with tissue sampling in a few cases.
  
  
  METHODS
  Completeness of inspection of the luminal and extraluminal cavity as well as tissue acquisition.
  
  
  RESULTS
  Complete upper GI endoscopy was performed in 17 of 20 and EUS in 8 of 8 cases. In addition, transgastric intra-abdominal endoscopy was successfully performed in 5 cases. Adequate histology from biopsy and EUS-guided puncture could be obtained in case of short time intervals post mortem. In 1 case, a rupture of the gastric cardia with bleeding was diagnosed as a significant unexpected finding. New minor pathological findings were revealed on EGD (6/17), GI EUS (3/8), and transgastric inspection (4/5).
  
  
  CONCLUSIONS
  Limited number of cases for all procedures.
  
  
  CONCLUSIONS
  Minimally invasive autopsy by using multiple endoscopic techniques for imaging and tissue acquisition is feasible. The significant value of this technique, in combination with virtual autopsy compared with classic autopsy, warrants further evaluation.
authors.affiliation: Department of Interdisciplinary Endoscopy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Ulrike W
authors.initials: UW
authors.lastname: Denzer
authors.forename: Daniel
authors.initials: D
authors.lastname: von Renteln
authors.forename: Andreas
authors.initials: A
authors.lastname: Lübke
authors.forename: Axel
authors.initials: A
authors.lastname: Heinemann
authors.forename: Thomas
authors.initials: T
authors.lastname: Rösch
authors.forename: Klaus
authors.initials: K
authors.lastname: Püschel
authors.forename: Tom
authors.initials: T
authors.lastname: Karbe
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy / Q000379:methods*; D001706:Biopsy / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D019160:Endosonography / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods; D055815:Young Adult
keywords: MRI; NOTES; PMI; magnetic resonance imaging; natural orifice transluminal endoscopic surgery; postmortem interval