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Review
. 2018 Jan;51(1):8-12.
doi: 10.5946/ce.2017.154. Epub 2018 Jan 23.

Introduction to Endoscopic Submucosal Surgery

Weon Jin Ko  1 , Joo Young Cho  2
Affiliations
Review

Introduction to Endoscopic Submucosal Surgery

Weon Jin Ko et al. Clin Endosc. 2018 Jan.

Abstract

The concept of using natural orifices to reduce the complications of surgery, Natural Orifices Transluminal Endoscopic Surgery, has also been applied to therapeutic endoscopy. Endoscopic submucosal surgery (ESS) provides more treatment options for various gastrointestinal diseases than traditional therapeutic endoscopy by using the submucosal layer as a working space. ESS has been performed in various fields ranging from transluminal peritoneoscopy to peroral endoscopic myotomy. With further advances in technology, ESS will be increasingly useful for diagnosis and treatment of gastrointestinal diseases.

Keywords: Endoscopic pyloromyotomy; Endoscopic submucosal surgery; Endoscopic submucosal tunnel dissection; Natural orifices transluminal endoscopic surgery; Peroral endoscopic myotomy.

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Conflict of interest statement

Conflicts of Interest:The authors have no financial conflicts of interest.

Figures

Fig. 1.
Fig. 1.
Schematic process of peroral endoscopic myotomy. (A) After injection, an incision is made. (B) Submucosal dissection is usually performed up to the cardia of the stomach. (C) Selective myotomy is performed with an endoscopic knife. (D) After selective myotomy, closure of the entry site is achieved with endoclips.
Fig. 2.
Fig. 2.
Endoscopic pyloromyotomy. (A) Submucosal injection 5 cm proximal to the pylorus. (B) After mucosal incision, submucosal dissection is usually performed up to the pylorus. (C) The pylorus is dissected until deeper layers are apparent. (D) Closure of the mucosal entry using standard hemoclips.
Fig. 3.
Fig. 3.
Endoscopic submucosal tunnel dissection for superficial esophageal cancer. (A) Marking the proximal and distal ends of the tumor. (B) Submucosal tunnel reached the distal end. (C, D) Circumferential submucosal dissection was completed. (E, F) The final specimen removed with endoscopic submucosal tunnel dissection.
See this image and copyright information in PMC

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