Access visualization systems

1. A method for placement of an endoscope adjacent to a target site, the method comprising:

positioning an access device adjacent to an opening in tissue to enter a pericardial space, the access device comprising a guide tube, a dilator member, and the endoscope, wherein the endoscope is integrated within the access device;

the dilator member having a proximal portion, a distal portion, a distal end, and a dilator passage extending from the proximal portion through the distal end, the dilator member further comprising a dilation surface being atraumatic and located about an outer surface at the distal portion, where a profile of the dilator surface increases in size along a proximal direction such that insertion of the dilator member in an opening in tissue dilates the tissue, the guide tube coupled to the dilator member and extending through the dilator passage, wherein the guide tube is configured to move axially relative to the dilator member, the guide tube further comprising an atraumatic end;

inserting the guide tube within the opening in tissue leading with the atraumatic end, the guide tube extending from the distal end of the dilator member and having a guide passage within the dilator passage, where the guide tube is independently manipulable from the endoscope when the guide tube is advanced distally through the dilator passage and past the distal end of the dilation member, where the guide tube maintains a tubular shape when advanced through the dilator passage;

dilating the opening in tissue by advancing the dilator member over the guide tube and toward the atraumatic end through the opening in tissue; and

imaging the target site using the endoscope while the endoscope is positioned through the dilator member.

2. The method of claim 1 , further comprising visualizing using the endoscope while inserting the guide tube within the opening.

3. The method of claim 1 , where the guide tube is transparent and further comprising visualizing through a wall of the guide tube using the endoscope.

4. The method of claim 1 , where the dilator member is transparent and further comprising visualizing through a wall of the guide tube using the endoscope.

5. The method of claim 1 , further comprising advancing the endoscope through the dilator member.

6. The method of claim 5 , further comprising advancing the endoscope through the guide tube.

7. The method of claim 1 , where imaging the target site using the endoscope comprises repositioning the dilator member to reposition the endoscope.

8. The method of claim 7 , further comprising advancing a second endoscope through the guide tube.

9. The method of claim 1 , further comprising advancing a guidewire through the opening in tissue and where inserting the guide tube comprises advancing the guide tube over the guidewire.

10. The method of claim 1 , where the dilator member is moveable over guide tube.

11. The method of claim 10 , further comprising removing the dilator member from the guide tube and advancing a second dilator member over the guide tube.

12. The method of claim 1 , further comprising a distensible or non-distensible balloon.

13. The method of claim 1 , wherein the guide tube is flexible.

14. The method of claim 1 , wherein the dilator member is slidable relative to the guide tube.

15. The method of claim 1 , wherein the distal end of the guide tube is tapered.