The New NOTES Expands Interventional Endoscopy

Natural orifice translumenal endoscopic surgery (NOTES) has been around for a dozen years or more without gaining much traction. Early pioneers had visions of incisionless removal of organs (eg, the gallbladder) using flexible endoscopes to breach an organ (eg, the stomach) to get the job done. These types of NOTES procedures were accomplished in some cases, but usually with no great benefit over standard laparoscopic technique. The New NOTES procedures emerged from Japan, where endoscopic submucosal dissection was extensively utilized mainly for en bloc removal of superficially spreading gastric cancer. This led to the development of POEM (per-oral endoscopic myotomy) for achalasia, which is finding new proponents all over the world. STER (submucosal tunneling for endoscopic resection of subepithelial tumors) and POP (per-oral pyloromyotomy) have also been introduced with seemingly great potential. Endoscopic suturing has concurrently been improved, allowing closure after EFTR (endoscopic full-thickness resection) of gastrointestinal tumors. This alphabet soup array of acronyms for New NOTES procedures may just be the beginning and promises to greatly expand the role of the interventional endoscopist.

It was almost preordained that Dr Stavros Stavropoulos would be leading the charge of the New NOTES. I have been able to watch Stavros develop as an interventionist from his days as a highly skilled Gastrointestinal Fellow (mentored by the late Dr Peter D. Stevens at Columbia-Presbyterian) to a master endoscopist in his own right, ready to explore the boundaries of flexible endoscopic surgery. He has gathered a Hall-of-Fame lineup of NOTES experts, covering all aspects of the New NOTES: the procedures, the perspectives, and the training.

If you are an interventional endoscopist in training or in practice, you should own this issue of the Gastrointestinal Endoscopy Clinics of North America . I believe it is a landmark volume, setting a different direction for the New NOTES that is up and rolling. Don’t miss the train.

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