Gastric surgery and notes.

Rather than being an end point in and of itself, NOTES offers an approach that encompasses the potential use of a natural orifice in conjunction with flexible instruments as a less invasive and more cosmetically appealing method of performing certain surgical procedures. Gastric surgery through natural orifices is one of the cutting-edge procedures in the evolving field of NOTES. The potential indications for NOTES involve a wide spectrum of upper gastrointestinal diseases, including achalasia, reflux disease, submucosal tumors, cancer, and morbid obesity. Although NOTES is becoming more widely used, most studies still involve only small numbers of patients, and the design of larger series and comparative trials to evaluate the early indications and results of NOTES is needed.