Natural orifice transluminal endoscopic surgery for the antireflux process in children

The successful deployment of therapeutic delivery systems with natural orifice transluminal endoscopic surgery (NOTES)-like techniques relies on a combination of technology that must be appropriate, and in children that includes size-specific, close team harmony with surgeons and endoscopists working hand in hand, absence of introduction of infection and other complications, and efficacy that is as good as the conventional approaches. Increasingly, cost will become a factor, and the higher cost of the NOTES-type techniques could be balanced by the potential for shorter stays as inpatients. Already the antireflux transoral incisionless fundoplication procedure has gained some acceptance in the United States, and it remains to be seen if it becomes commonplace in pediatrics. How long it will take for other techniques such as NOTES cholecystectomy, appendectomy, bowel resection, etc., to be adopted in a similar fashion will depend on the ongoing studies that are bearing fruit every year, and also on technological developments such as the so-called NOTES “toolbox.” These are interesting times for pediatric gastrointestinal endoscopy