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

TY - JOUR

T1 - Minimally invasive autopsy by using postmortem endoluminal and transluminal endoscopy and EUS

AU - Denzer, Ulrike W

AU - von Renteln, Daniel

AU - Lübke, Andreas

AU - Heinemann, Axel

AU - Rösch, Thomas

AU - Püschel, Klaus

AU - Karbe, Thomas

N1 - Copyright © 2013 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

PY - 2013/11/1

Y1 - 2013/11/1

N2 - BACKGROUND: Virtual 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.OBJECTIVES: We present the first series of sequential endoscopic techniques including natural orifice transluminal access for minimally invasive autopsy.SETTING: University hospital, legal medicine department.SUBJECTS: Twenty deceased subjects.INTERVENTION: Various 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 MEASUREMENTS: Completeness of inspection of the luminal and extraluminal cavity as well as tissue acquisition.RESULTS: Complete 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).LIMITATIONS: Limited number of cases for all procedures.CONCLUSION: Minimally 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.

AB - BACKGROUND: Virtual 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.OBJECTIVES: We present the first series of sequential endoscopic techniques including natural orifice transluminal access for minimally invasive autopsy.SETTING: University hospital, legal medicine department.SUBJECTS: Twenty deceased subjects.INTERVENTION: Various 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 MEASUREMENTS: Completeness of inspection of the luminal and extraluminal cavity as well as tissue acquisition.RESULTS: Complete 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).LIMITATIONS: Limited number of cases for all procedures.CONCLUSION: Minimally 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.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Autopsy

KW - Biopsy

KW - Endoscopy

KW - Endosonography

KW - Feasibility Studies

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Natural Orifice Endoscopic Surgery

KW - Young Adult

U2 - 10.1016/j.gie.2013.07.036

DO - 10.1016/j.gie.2013.07.036

M3 - SCORING: Journal article

C2 - 24021488

VL - 78

SP - 774

EP - 780

JO - GASTROINTEST ENDOSC

JF - GASTROINTEST ENDOSC

SN - 0016-5107

IS - 5

ER -