Natural-orifice transluminal endoscopic surgery (NOTES) using flexible endoscopy has attracted attention as a minimally invasive surgical method that does not cause an operative wound on the body surface. However, minimizing the number of devices involved in endoscopic, compared to laparoscopic, surgeries has remained a challenge, causing endoscopic surgeries to gradually be phased out of use. If a flexible endoscopic full-thickness suturing device and a counter-traction device were developed to expand the surgical field for gastrointestinal-tract collapse, then endoscopic full-thickness resection using NOTES, which is seen as an extension of endoscopic submucosal dissection for full-thickness excision of tumors involving the gastrointestinal-tract wall, might become an extremely minimally invasive surgical method that could be used to resect only full-thickness lesions approached by the shortest distance via the mouth. It is expected that gastroenterological endoscopists will use this surgery if device development is advanced. This extremely minimally invasive surgery would have an immeasurable impact with regard to mitigating the burden on patients and reducing healthcare costs. Development of a new surgical method using a multipurpose flexible endoscope is therefore considered a socially urgent issue.
Dissection/economics/instrumentation/*methods ; Gastrointestinal Neoplasms/pathology/*surgery ; Health Care Costs ; Humans ; Medical Illustration ; Mouth ; Natural Orifice Endoscopic Surgery/economics/instrumentation/*methods ; Upper Gastrointestinal Tract/*surgery

Endoscopic treatment can be a curative option for small carcinoid tumors with an extremely low risk of metastasis. Since most carcinoid tumors are characterized by a specific growth pattern in the submucosal (SM) layer, specialized endoscopic techniques for deeper resection to achieve clear vertical margins are needed. The endoscopic submucosal dissection (ESD) method in the SM space is superior to conventional endoscopic mucosal resection. However, the standard ESD technique sometimes fails to provide complete deep SM dissection due to insufficient SM lifting. Here, to resolve this problem, we describe our initial experience with an endoscopic SM tunneling technique that is effective for treating rectal carcinoid tumors.
Carcinoid Tumor* ; Endoscopy, Gastrointestinal ; Lifting ; Methods ; Neoplasm Metastasis

PURPOSE: Pain from osteoarthritis (OA) is generally classified as nociceptive (inflammatory). Animal models of knee OA have shown that sensory nerve fibers innervating the knee are significantly damaged with destruction of subchondral bone junction, and induce neuropathic pain (NP). Our objective was to examine NP in the knees of OA patients using painDETECT (an NP questionnaire) and to evaluate the relationship between NP, pain intensity, and stage of OA. MATERIALS AND METHODS: Ninety-two knee OA patients were evaluated in this study. Pain scores using Visual Analogue Scales (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), painDETECT, duration of symptoms, severity of OA using the Kellgren-Lawrence (KL) system, and amount of joint fluid were evaluated and compared using a Spearman's correlation coefficient by rank test. RESULTS: Our study identified at least 5.4% of our knee OA patients as likely to have NP and 15.2% as possibly having NP. The painDETECT score was significantly correlated with the VAS and WOMAC pain severity. Compared with the painDETECT score, there was a tendency for positive correlation with the KL grade, and tendency for negative correlation with the existence and amount of joint fluid, but these correlations were not significant. CONCLUSION: PainDETECT scores classified 5.4% of pain from knee OA as NP. NP tended to be seen in patients with less joint fluid and increased KL grade, both of which corresponded to late stages of OA. It is important to consider the existence of NP in the treatment of knee OA pain.
Aged ; Aged, 80 and over ; Female ; Humans ; Knee/pathology/physiopathology ; Male ; Middle Aged ; Neuralgia/*physiopathology ; Osteoarthritis, Knee/*physiopathology