Per-oral endoscopic salpingo-oophorectomy (POESY) in humans: a prospective clinical feasibility study.

Background And Aims: Natural orifice translumenal endoscopic surgery (NOTES) procedure describes a surgical approach using natural orifices. We describe a prospective non-comparative clinical study on transgastric salpingo-oophorectomy in humans.

Methods: Patients with indication for salpingo-oophorectomy were offered the transgastric approach.

Submucosal injection with waterjet improves endoscopic mucosal resection of colorectal adenoma - a randomised controlled clinical trial.

Purpose: Endoscopic mucosal resection (EMR) of colorectal adenomas leads to a reduced incidence of, and mortality from, colorectal carcinoma. Large adenomas are especially difficult to resect. Submucosal injection is a key part of EMR, as it allows for complete resection and decreased complications.

Analysis of the First 217 Appendectomies of the German NOTES Registry.

Objective: To analyze the feasibility and safety of Natural Orifice Transluminal Endoscopic Surgery (NOTES) appendectomy, and to analyze separately the transvaginal appendectomy (TVAE) and the transgastric appendectomy (TGAE) procedures.

Background: Laparoscopic appendectomy has rare but relevant complications, namely incisional hernias and neuralgia at the trocar sites, which can potentially be avoided by the NOTES techniques.

Methods: The first 217 data sets of the largest NOTES registry worldwide-the German NOTES registry-were analyzed with respect to demographic data, procedural data, and short-term outcomes.

Endoscopic application of polysaccharide powder for hemostasis in anticoagulated pigs (with video).

Background: Acute GI bleeding remains a clinical problem of daily importance. Increasing numbers of patients with compromised coagulation challenge the established methods of endoscopic hemostasis. Therefore, new powders for the treatment of GI bleeding have been developed.

Natural orifice transluminal endoscopic surgery in humans: feasibility and safety of transgastric closure using the OTSC system.

Background: NOTES is a technique in which an operation is performed within the body without a skin incision by using a natural body orifice to provide access. The principal challenge of transgastric NOTES procedures is still the feasibility and safety of access closure. Currently, there are very limited data regarding the closure of transgastric NOTES in humans, and the standard method and device for closure has not been defined.

Pure natural orifice transluminal endoscopic surgery (NOTES) involving peroral endoscopic salpingo-oophorectomy (POESY).

Objective: Natural orifice transluminal endoscopic surgery (NOTES) is a surgical approach that uses natural orifices to gain access to areas of the body. In the present article, we describe the first transgastric pure NOTES salpingo-oophorectomy, which we call peroral endoscopic salpingo-oophorectomy (POESY).

Methods: A woman with BRCA1 mutation presented for prophylactic bilateral salpingo-oophorectomy.

Recurrence after endoscopic mucosal resection-therapy failure?

Purpose: To evaluate the success and complication rates of endoscopic mucosal resections (EMR) for large flat adenomas and to identify risk factors for adenoma recurrence.

Methods: We evaluated all consecutive patients treated with EMR at our institution between 2003 and 2005 that fulfilled the following criteria: >10-mm diameter, Paris 0-Is and 0-IIa-c, and endoscopic follow-up. We conducted univariate analysis and multivariate analysis using a non-stratified logistic regression model to identify possible influencing factors.

New methods of magnet-based instrumentation for NOTES.

Introduction: Laparoscopic surgery has displaced open surgery as the standard of care for many clinical conditions. NOTES has been described as the next surgical frontier with the objective of incision-free abdominal surgery. The principal challenge of NOTES procedures is the loss of triangulation and instrument rigidity, which is one of the fundamental concepts of laparoscopic surgery.

Fluctuating ideal-gas lattice Boltzmann method with fluctuation dissipation theorem for nonvanishing velocities.

Current implementations of fluctuating ideal-gas descriptions with the lattice Boltzmann methods are based on a fluctuation dissipation theorem, which, while greatly simplifying the implementation, strictly holds only for zero mean velocity and small fluctuations. We show how to derive the fluctuation dissipation theorem for all k, which was done only for k=0 in previous derivations. The consistent derivation requires, in principle, locally velocity-dependent multirelaxation time transforms.

Differences in the endoscopic closure of colonic perforation due to diagnostic or therapeutic colonoscopy.

Objective: To describe the experience of a single center regarding the feasibility of endoscopic closure of iatrogenic colonic perforations and to elucidate differences between the efficacy of endoscopic clip closure due to diagnostic or therapeutic colonoscopy.

Material And Methods: A retrospective institutional computer-based search of records of colonoscopic perforation occurring between January 2004 and December 2011 was undertaken. Data on patients undergoing colonoscopy were entered into a clinical database.

Transgastric appendicectomy.

Background: Experimental studies and small anecdotal reports have documented the potential and feasibility of transgastric appendicectomy. This paper reports the results of the new technique in a selected group of patients.

Methods: From April 2010 transgastric appendicectomy was offered to all patients with acute appendicitis, but without generalized peritonitis or local contraindications.

The EURO-NOTES clinical registry for natural orifice transluminal endoscopic surgery: a 2-year activity report.

Background: The EURO-NOTES Clinical Registry (ECR) was established as a European database to allow the monitoring and safe introduction of Natural Orifice Transluminal Endoscopic Surgery (NOTES). The aim of this study was to analyze different techniques applied and relative results during the first 2 years of the ECR.

Methods: The ECR was designed as a voluntary database with online access.

Experimental endoscopic submucosal dissection training in a porcine model: learning experience of skilled Western endoscopists.

Background: Endoscopic submucosal dissection (ESD) demands a new level of endoscopic skill in Europe. A 2-day workshop was set up for trainees to carry out five ESD each in order to obtain the skill level required to perform ESD in the stomach or rectum. This study describes: (i) the workshop setup; (ii) the participant's performance; and (iii) the training effect on post-workshop clinical ESD performance.

Temporary cystogastrostomy with self-expanding metallic stents for pancreatic necrosis.

Conventional endoscopic drainage of symptomatic pancreatic pseudocysts has its limitations when the content of the collection is nonfluid. This leads to obstruction of placed flap stents; it requires the placement of an irrigation catheter and repeated implantation of several stents. Herein we describe the temporary use of a special self-expanding partially covered metal mesh stent, which was designed to keep the pancreaticogastrostomy open for drainage of walled-off necrosis and for further endoscopic necrosectomies.

Endoscopic application of hemostatic thrombin-gelatin matrix (FloSeal) in anticoagulated pigs.

Flexible endoscopy is the method of choice for the diagnosis and therapy of upper gastrointestinal bleeding, but there are still problems during therapy of patients with coagulation disorders. FloSeal((R)) is a hemostatic matrix largely independent of the body's own clotting system. A newly developed endoscopic applicator for FloSeal((R)) was tested in a survival study on pigs with impaired clotting.

Topoisomerase I expression correlates to response to neoadjuvant irinotecan-based chemoradiation in rectal cancer.

Biomarkers may help predict the efficacy of neoadjuvant chemoradiation in patients with rectal cancer. We hypothesized that the expression of topoisomerase I (Topo I) and thymidylate synthase (TS) may help predict the treatment response in patients undergoing irinotecan and capecitabine-based chemoradiation. Patients with rectal cancer (cT3/4Nx or Tx/N+) received neoadjuvant chemoradiotherapy within clinical studies with irinotecan and capecitabine.

Combination of water-jet dissection and needle-knife as a hybrid knife simplifies endoscopic submucosal dissection.

Background: The safety and efficacy of endoscopic submucosal dissection (ESD) is very dependent on an effective injection beneath the submucosal lamina and on a controlled cutting technique. After our study group demonstrated the efficacy of the HydroJet in needleless submucosal injections under various physical conditions to create a submucosal fluid cushion (Selective tissue elevation by pressure = STEP technique), the next step was to develop a new instrument to combine the capabilities of an IT-Knife with a high-pressure water-jet in a single instrument. In this experimental study, we compared this new instrument with a standard ESD technique.

Comparison of standard endoscopic submucosal dissection (ESD) versus an optimized ESD technique for the colon: an animal study.

Background And Study Aims: Endoscopic submucosal dissection (ESD) is a promising therapeutic technique for en bloc resection of large gastrointestinal tumors. However, this technique has disadvantages such as a long intervention time, complexity of the procedure, and a higher rate of complications. The primary aims of the study were to show the feasibility of ESD in the pig colon and to evaluate a new ESD technique comprising the use of a newly developed hybrid knife for colon procedures combining RF (radiofrequency) application and a distance-dependent water-jet application.

Endoscopic closure of the natural orifice transluminal endoscopic surgery (NOTES) access site to the peritoneal cavity by means of transmural resorbable sutures: an animal survival study.

Background And Study Aims: Endoscopic closure of the transgastric access site is still a critical area of active research and development into natural orifice transluminal surgery (NOTES). To date, no endoscopic technique has utilized resorbable transmural sutures for closure of the NOTES gastrostomy.

Material And Methods: Endoscopic gastrostomy closure by means of resorbable sutures was performed in ten female domestic pigs in an animal survival study.

Preoperative staging of rectal tumors: comparison of endorectal ultrasound, hydro-CT, and high-resolution endorectal MRI.

Aim: The aim of this study was to compare transrectal ultra-sound (TRUS), hydro-computed tomography (hydro-CT), and endorectal magnetic resonance imaging (MRI) in the preoperative staging of rectal cancer.

Patients And Methods: 23 patients with rectal adenocarcinoma underwent TRUS, hydro-CT, and MRI (1 Tesla) with endorectal coil. The results were correlated with the histopathological findings based on the TNM classification.

The Merendino procedure following preoperative imatinib mesylate for locally advanced gastrointestinal stromal tumor of the esophagogastric junction.

Background: Gastrointestinal stromal tumors (GIST) of the esophagogastric junction might pose a major problem to surgical resection. If locally advanced, extended or multivisceral resection with relevant procedural-specific morbidity and mortality is often necessary.

Case Presentation: We report a case of a patient with a locally advanced GIST of the esophagogastric junction who was treated by transhiatal resection of the lower esophagus and gastric cardia with reconstruction by interposition of segment of the jejunum (Merendino procedure).

Endoclipping of iatrogenic colonic perforation to avoid surgery.

Background: Colonoscopy is an established tool for the diagnosis and management of colonic and rectal pathology. Even though colonic perforation is rare after colonoscopy, it is a serious and typical complication. The definitive management remains controversial.

Submucosal cushioning with water jet before endoscopic mucosal resection : Which fluids are effective?

Background: Several new techniques have recently been described that allow the endoscopic mucosal resection even of broad-based flat lesions in the gastrointestinal tract. The technique recently described by us of using a water jet dissector (Helix HydroJet) for a selective deposition of liquid in the submucosal lamina has now been combined with different substances, and their effects have been compared.

Material And Methods: Gastroscopies were carried out in 8 pigs under intubation anesthesia, and 2 submucosal cushions each were created in the stomach using one out of 4 test substances (gelatin, glucose 50, hydroxyethyl starch [HES] 10%, dextran 40), as well as one cushion of isotonic saline solution placed in each area via the Helix HydroJet).

Selective fluid cushion in the submucosal layer by water jet: advantage for endoscopic mucosal resection.

Background/aim: Numerous new techniques have recently been reported and described for the endoscopic mucosal resection of large superficial lesions of the gastrointestinal tract. We present here for the first time the application of a water jet dissector for mucosa elevation.

Materials And Methods: In an ex vivo study, the effectiveness of a water jet dissector (Helix Hydro-Jet) placed directly on the stomach walls of 8 pigs was examined to create a mucosal elevation.