Is there a place for N.O.T.E.S. in the diagnosis and treatment of neoplastic lesions of the pancreas?

Natural orifice transluminal endoscopic surgery (NOTES) is the latest minimally invasive technique in the surgical armamentarium. Indeed it is stoking controversy already among both practitioners and patients, challenging established surgical, ethical and even moral principles. One organ which has been at the forefront of minimally invasive intervention is the pancreas. This review looks at the basis for evolving NOTES capabilities in the diagnosis and treatment of pancreatic diseases, with particular reference to neoplastic lesions and their complications. A summary of recent advancements in gastro-intestinal endoscopy and laparoscopic surgery as applied to the pancreas is presented. The possible role and feasibility of NOTES are outlined against this background.