Forward-viewing endoscopic ultrasound-guided NOTES interventions: a study on peritoneoscopic potential.
OBJECTIVE
To evaluate the feasibility of diagnostic and therapeutic transgastric (TG) peritoneoscopic interventions with a forward-viewing endoscopic ultrasound (FV-EUS).


METHODS
This prospective endoscopic experimental study used an animal model. Combined TG peritoneoscopic interventions and EUS examination of the intra-abdominal organs were performed using an FV-EUS on 10 animal models (1 porcine and 9 canine). The procedures carried out include EUS evaluation and endoscopic biopsy of intraperitoneal organs, EUS-guided fine needle aspiration (EUS-FNA), EUS-guided radiofrequency ablation (EUS-RFA), and argon plasma coagulation (APC) for hemostatic control. The animals were kept alive for 7 d, and then necropsy was performed to evaluate results and complications.


RESULTS
In all 10 animals, TG peritoneoscopy, followed by endoscopic biopsy for the liver, spleen, abdominal wall, and omentum, was performed successfully. APC helped control minor bleeding. Visualization of intra-abdominal solid organs with real-time EUS was accomplished with ease. Intraperitoneal EUS-FNA was successfully performed on the liver, spleen, and kidney. Similarly, a successful outcome was achieved with EUS-RFA of the hepatic parenchyma. No adverse events were recorded during the study.


CONCLUSIONS
Peritoneoscopic natural orifice transluminal endoscopic surgery (NOTES) interventions through FV-EUS were feasible in providing evaluation and performing endoscopic procedures. It promises potential as a platform for future EUS-based NOTES.
Seung Uk Jeong, Hassanuddin Aizan, Dong Wan Seo, Do Hyun Park, Sang Soo Lee, Sung Koo Lee, Myung-Hwan Kim, Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, South Korea.
Seung Uk
SU
Jeong
Hassanuddin
H
Aizan
Tae Jun
TJ
Song
Dong Wan
DW
Seo
Su-Hui
SH
Kim
Do Hyun
DH
Park
Sang Soo
SS
Lee
Sung Koo
SK
Lee
Myung-Hwan
MH
Kim
D000818:Animals; D057908:Argon Plasma Coagulation / Q000379:methods; D017115:Catheter Ablation / Q000379:methods; D004285:Dogs; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D019160:Endosonography / Q000009:adverse effects / Q000379:methods*; D005240:Feasibility Studies; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D023421:Models, Animal; D057605:Natural Orifice Endoscopic Surgery / Q000009:adverse effects / Q000379:methods*; D013552:Swine; D013556:Swine, Miniature; D018084:Ultrasonography, Interventional / Q000009:adverse effects / Q000379:methods*
Endoscopic ultrasound guided intervention; Forward-viewing endoscopic ultrasound; Natural orifice transluminal endoscopic surgery; Oblique-viewing endoscopic ultrasound; Peritoneoscopy