Natural orifice transluminal endoscopic surgery (NOTES) as a diagnostic tool in the XXXX .

@entity1 @entity1707 @entity63 @entity384 @entity1661 @entity5274 @entity1213 @entity5327
BACKGROUND: Autopsy studies confirm that many @entity1213 ( @entity1213 ) @entity1 die from unrecognized sources of @entity1661 or @entity63 . Computed tomography (CT) scans can be of limited use for these diagnoses and difficult to obtain in critically ill @entity1 who require significant support for transport. Bedside laparoscopy has been described but still is cumbersome to perform. Bedside flexible endoscopy as a diagnostic tool or for placement of @entity5274 is a standard @entity1213 procedure. Natural orifice transluminal endoscopic surgery (NOTES) can provide access to the peritoneal cavity as a bedside procedure and may decrease the number of @entity1 with unrecognized intra-abdominal catastrophic events. METHODS: @entity1707 were anesthetized and peritoneal access with the flexible endoscope was obtained using a guidewire, needle knife cautery, and @entity384 . The transgastric endoscope was used to explore all quadrants of the abdominal cavity. The small bowel was visualized to complete the exploration. The transgastric access location was then managed with the use of a @entity5274 . The animals were euthanized and analyzed. RESULTS: Eight @entity1707 were studied and complete abdominal exploration, including diaphragm visualization, was possible in all cases. Endoscopy-guided biopsies were performed, adhesions lysed, and the gallbladder successfully drained percutaneously. The small bowel was run successfully with percutaneous needlescopic suture graspers. CONCLUSIONS: These animal studies support the concept that NOTES, with management of the gastric opening with a @entity5274 , may be another approach for finding unrecognized sources of @entity1661 or @entity5327 in difficult @entity1213 @entity1 . These encouraging results warrant a prospective @entity1 trial to assess safety and efficacy.
