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

Abstract

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.

Keywords: MRI; NOTES; PMI; magnetic resonance imaging; natural orifice transluminal endoscopic surgery; postmortem interval.