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Dig Dis Sci. 2013 Aug;58(8):2167-76. doi: 10.1007/s10620-013-2637-6. Epub 2013 Mar 21.

Chinese physician perception of natural orifice translumenal endoscopic surgery.

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Department of Gastroenterology and Hepatology, The General Hospital of the Chinese People's Liberation Army, Beijing, China.



A gross difference of opinion prevails amongst the physicians about the acceptance of natural orifice translumenal endoscopic surgery (NOTES).


The purpose of this study was to explore the Chinese physician perception of NOTES.


This is a questionnaire-based study, which was conducted during a conference on gastroenterology and endoscopy. The information was obtained from the participants about the demographic and practice characteristics and their perception of NOTES.


The study recruited 221 physicians: 192 gastroenterologists and 29 surgeons. The physicians' awareness of NOTES prior to the survey showed the same confidence with NOTES as compared to those with no knowledge about it (24.2 vs. 25.6 %; P = 0.99). The NOTES preference was not different between female and male doctors (21.8 vs. 26.3 %; P = 0.5952). More surgeons (47.6 %) opted for NOTES as treatment or recommended it for their families than gastroenterologists (21.1 %; P = 0.0165). However, the multivariate analysis confirmed that the physicians chose NOTES only if their hospital had already performed NOTES on humans successfully (OR = 3.53, 95 % CI 1.17-10.60; P = 0.0247). The gastroenterologists believed more often than surgeons that NOTES had the potential to become a mainstream procedure (96.9 vs. 81.0 %; P = 0.0084); but the inclination for NOTES training was similar in both groups (96.9 vs. 95.2 %; P = 0.8027). Safety of NOTES was their major concern and the choice of ideal entry point was thought to be the key barrier to NOTES clinical application. Hybrid NOTES was regarded as the best method for NOTES clinical application at the time of the study.


Physicians were hesitant when considering the NOTES approach. However, most of the physicians were interested in NOTES training and had confidence in NOTES.

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