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Transcolonic natural orifice transluminal endoscopic surgery (NOTES) is a promising technique for but not limited to periappendiceal lesions
  1. Tao Chen,
  2. Meidong Xu
  1. Endoscopy Center, Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
  1. Correspondence to Dr Meidong Xu, Endoscopy Center, Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China; 1800512{at}

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We thank Shah S et al 1 for their interest in our study about a promising natural orifice transluminal endoscopic surgery (NOTES) technique, transcolonic endoscopic appendicectomy (TEA).2 We are happy to respond to their comments. With the development of flexible endoscope, endoscopic surgery is opening a door for NOTES. Similarly, TEA eliminates abdominal incisions and has several advantages.3 However, TEA has a major challenge with complex interventions relates to the technical difficulty in extraction without the assistance of laparoscope. In the procedures of our early cases, the average duration exceeded 100 min. But, with the increasing experience and proficiency, especially in the development of traction techniques and new endoscopic instruments with both electric cutting and coagulation functions, the procedure time was significantly reduced in recent cases, around 50 min. Meanwhile, the postoperative care was also improved and average hospitalisation was reduced.

Traditionally, endoscopic treatment of sessile serrated lesions (SSLs) deeply involving the appendiceal orifice is challenging. In cases where the lesion greatly extends away from …

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  • Contributors TC and MX drafted the manuscript. TC and MX revised the manuscript. All authors contributed equally to the letter.

  • Funding This work was supported by Medical Discipline Construction Project of Pudong Health Committee of Shanghai (PWYgf2021-2 (MX)), Shanghai Committee of Science and Technology (20XD1402900 (MX) and 21XD1423100 (TC)), and National Natural Science Foundation of China (82072684 (MX) and 82073224 (TC)).

  • Disclaimer The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. All other authors disclosed no financial relationships relevant to this publication.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.