ArticleFrontiers in surgery2026
Feasibility of embryonic-natural orifice transluminal endoscopic surgery for submucosal tumors with mucosal preservation in beagle model.
Article in Frontiers in surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background and aims: While endoscopic resection techniques such as endoscopic submucosal excavation (ESE) or endoscopic full-thickness resection (EFTR) enable the removal of gastrointestinal muscularis propria-originating submucosal tumors (MP-SMTs), these procedures still present certain limitations, including risks of perforation and hemorrhage. Therefore, we developed a novel embryonic-natural orifice transluminal endoscopic surgery (E-NOTES) approach designed to achieve complete resection of MP-SMTs while preserving mucosal integrity. This study evaluated its feasibility in beagle model. Methods: Twelve healthy beagles underwent E-NOTES using a gastric endoscope. Simulated lesions were created on the serosal surface of the gastric anterior wall. The muscularis propria and serosal layers were resected while maintaining mucosal integrity. Simulated lesion size, operative time, intraoperative hemorrhage, intra-/ postoperative complications were recorded and analyzed. Postoperative endoscopy at 60 days and histopathological examination were performed to assess outcomes. Results: All procedures were successfully completed without conversion to laparoscopy. The mean simulated lesion diameter was 28.1 ± 7.7 mm, and mean operative time was 64.3 ± 5.5 min. Minor intraoperative bleeding (< 5 mL) occurred in 7/12 (58.3%) dogs and was controlled endoscopically. No severe complications (perforation, peritonitis, or major bleeding) occurred. All animals resumed oral intake within 24 h. Endoscopy on postoperative day 60 confirmed complete mucosal healing, and histopathology verified the complete excision of the targeted full-thickness muscularis propria and the preservation of mucosal layers. Conclusion: In this preclinical canine model, E-NOTES enabled safe and complete resection of gastric MP-SMTs with intact mucosa in a beagle model, demonstrating minimal invasiveness, low complication rates, and rapid recovery. These findings support further technical refinement and cautious evaluation in subsequent translational studies.
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