Abstract
Mori et al. [1] discuss the possibility of using a conventional flexible endoscope during pure natural orifice transluminal endoscopic surgery (NOTES) in patients with gastric gastrointestinal stromal tumors (GISTs), which is a really amazing idea. They use several novel techniques during full-thickness resection of GISTs, which may lay the foundation for the realization of pure NOTES using only conventional flexible endoscopes. First, a nasal endoscope was introduced to either create a perforation or assist in pulling up the collapsed gastric wall to prevent the operative view from being obscured. Second, a duodenal balloon was used to prevent gas from flowing beyond the outlet of the stomach and causing uncomfortable distention of the intestine. Third, unlike previous studies, perforation was made at 10-mm intervals instead of a continuous incision, a process that can also provide landmarks for resection of GISTs.
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