Minimally invasive autopsy by using postmortem endoluminal and transluminal endoscopy and EUS

BackgroundVirtual autopsy by using CT imaging has been introduced as an alternative to conventional autopsy and has resulted in an increase in acceptance of autopsy by relatives. Because direct inspection and tissue acquisition is not possible by imaging alone, various endoscopic techniques can be considered of complementary usefulness.ObjectivesWe present the first series of sequential endoscopic techniques including natural orifice transluminal access for minimally invasive autopsy.SettingUniversity hospital, legal medicine department.SubjectsTwenty deceased subjects.InterventionVarious flexible endoscopic modalities including EUS, with biopsy or EUS-guided FNA, were attempted. This included transluminal intra-abdominal endoscopic exploration with tissue sampling in a few cases.Main Outcome MeasurementsCompleteness of inspection of the luminal and extraluminal cavity as well as tissue acquisition.ResultsComplete upper GI endoscopy was performed in 17 of 20 and EUS in 8 of 8 cases. In addition, transgastric intra-abdominal endoscopy was successfully performed in 5 cases. Adequate histology from biopsy and EUS-guided puncture could be obtained in case of short time intervals post mortem. In 1 case, a rupture of the gastric cardia with bleeding was diagnosed as a significant unexpected finding. New minor pathological findings were revealed on EGD (6/17), GI EUS (3/8), and transgastric inspection (4/5).LimitationsLimited number of cases for all procedures.ConclusionMinimally invasive autopsy by using multiple endoscopic techniques for imaging and tissue acquisition is feasible. The significant value of this technique, in combination with virtual autopsy compared with classic autopsy, warrants further evaluation.