Over the years,our growing experience with endoscopic submucosal dissection along with technological advances has so-lidified our comfort and knowledge on working in the submucosa,also referred to as the“third space....Over the years,our growing experience with endoscopic submucosal dissection along with technological advances has so-lidified our comfort and knowledge on working in the submucosa,also referred to as the“third space.”Per-oral endoscopic myotomy(POEM)was thefirst prototype third-space endoscopy(TSE)procedure,demonstrating the feasibility and clinical utility of endoscopic esophagogastric myotomy via submucosal tunneling.The launch of POEM accelerated the evolution of TSE from a vanguard concept to an expandingfield with a wide range of clinical applications.In this review,we discuss the status and future directions of multiple TSE interventions.展开更多
Third-space endoscopy(TSE)has emerged as an effective treatment modality for various gastrointestinal motility diseases and gastrointestinal tumors.TSE is based on the concept of working in the submucosa using a mucos...Third-space endoscopy(TSE)has emerged as an effective treatment modality for various gastrointestinal motility diseases and gastrointestinal tumors.TSE is based on the concept of working in the submucosa using a mucosal flap valve technique,which is the underlying premise for all TSE procedures;thus,some complications are shared across the spectrum of TSE procedures.Despite the high safety profiles of most TSE procedures,studies have reported various adverse events,including insufflation-related complications,bleeding,perforation,and infection.Although the occurrence rate of those complications is not very high,they sometimes result in critical conditions.No reports of chylous effusion following TSE procedures,particularly per-oral endoscopic myotomy,have been documented previously.We are presenting the first reported case of chylous pleural effusion after per-oral endoscopic myotomy.Additionally,we aim to present a comprehensive overview,discuss the existing data,and provide insights into pulmonary post-endoscopic complications in light of recent advancements in endoscopic procedures,especially TSE.展开更多
Third-space endoscopy,also known as intramural surgery,represents a major evolution in minimally invasive gastrointestinal interventions.While natural orifice transluminal endoscopic surgery provided early conceptual ...Third-space endoscopy,also known as intramural surgery,represents a major evolution in minimally invasive gastrointestinal interventions.While natural orifice transluminal endoscopic surgery provided early conceptual groundwork,third-space endoscopy builds upon it by maintaining interventions within the submucosal layer,offering improved precision and reduced risk.The creation of a controlled submucosal working space enables precise therapeutic interventions while potentially reducing the morbidity associated with traditional surgical approaches.Among its most impactful applications are the peroral endoscopic myotomy techniques,including cricopharyngeal,esophageal,gastric,and Zenker’s myotomies.These procedures have redefined the management of cricopharyngeal bar,achalasia,gastroparesis,and Zenker’s diverticulum,respectively.These techniques offer durable symptom relief with reduced recovery times.Over the past five years,refinements in technique,advancements in instrumentation,technology,and improved patient selection have expanded indications and enhanced safety.However,challenges remain,including the limited standardization and accessibility to specialized training.This review provides a comprehensive analysis of the evolution,technical refinements,and clinical outcomes of thirdspace endoscopy,with a focus on its expanding role in foregut surgery.By consolidating current evidence and highlighting future directions,we aim to provide a critical perspective on the impact of intramural surgery and its potential to further transform the management of complex gastrointestinal disorders.展开更多
文摘Over the years,our growing experience with endoscopic submucosal dissection along with technological advances has so-lidified our comfort and knowledge on working in the submucosa,also referred to as the“third space.”Per-oral endoscopic myotomy(POEM)was thefirst prototype third-space endoscopy(TSE)procedure,demonstrating the feasibility and clinical utility of endoscopic esophagogastric myotomy via submucosal tunneling.The launch of POEM accelerated the evolution of TSE from a vanguard concept to an expandingfield with a wide range of clinical applications.In this review,we discuss the status and future directions of multiple TSE interventions.
文摘Third-space endoscopy(TSE)has emerged as an effective treatment modality for various gastrointestinal motility diseases and gastrointestinal tumors.TSE is based on the concept of working in the submucosa using a mucosal flap valve technique,which is the underlying premise for all TSE procedures;thus,some complications are shared across the spectrum of TSE procedures.Despite the high safety profiles of most TSE procedures,studies have reported various adverse events,including insufflation-related complications,bleeding,perforation,and infection.Although the occurrence rate of those complications is not very high,they sometimes result in critical conditions.No reports of chylous effusion following TSE procedures,particularly per-oral endoscopic myotomy,have been documented previously.We are presenting the first reported case of chylous pleural effusion after per-oral endoscopic myotomy.Additionally,we aim to present a comprehensive overview,discuss the existing data,and provide insights into pulmonary post-endoscopic complications in light of recent advancements in endoscopic procedures,especially TSE.
文摘Third-space endoscopy,also known as intramural surgery,represents a major evolution in minimally invasive gastrointestinal interventions.While natural orifice transluminal endoscopic surgery provided early conceptual groundwork,third-space endoscopy builds upon it by maintaining interventions within the submucosal layer,offering improved precision and reduced risk.The creation of a controlled submucosal working space enables precise therapeutic interventions while potentially reducing the morbidity associated with traditional surgical approaches.Among its most impactful applications are the peroral endoscopic myotomy techniques,including cricopharyngeal,esophageal,gastric,and Zenker’s myotomies.These procedures have redefined the management of cricopharyngeal bar,achalasia,gastroparesis,and Zenker’s diverticulum,respectively.These techniques offer durable symptom relief with reduced recovery times.Over the past five years,refinements in technique,advancements in instrumentation,technology,and improved patient selection have expanded indications and enhanced safety.However,challenges remain,including the limited standardization and accessibility to specialized training.This review provides a comprehensive analysis of the evolution,technical refinements,and clinical outcomes of thirdspace endoscopy,with a focus on its expanding role in foregut surgery.By consolidating current evidence and highlighting future directions,we aim to provide a critical perspective on the impact of intramural surgery and its potential to further transform the management of complex gastrointestinal disorders.
