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Review
. 2023 Jan 10:11:goac077.
doi: 10.1093/gastro/goac077. eCollection 2023.

Third-space endoscopy: the final frontier

Maham Hayat  1 , Dennis Yang  1 , Peter V Draganov  2
Affiliations
Review

Third-space endoscopy: the final frontier

Maham Hayat et al. Gastroenterol Rep (Oxf). .

Abstract

Over the years, our growing experience with endoscopic submucosal dissection along with technological advances has solidified our comfort and knowledge on working in the submucosa, also referred to as the "third space." Per-oral endoscopic myotomy (POEM) was the first 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 expanding field with a wide range of clinical applications. In this review, we discuss the status and future directions of multiple TSE interventions.

Keywords: endoscopy; final frontier; submucosal endoscopy; therapeutic endoscopy; third-space endoscopy.

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Figures

Figure 1.
Figure 1.
Step-by-step of per-oral endoscopic myotomy (POEM). (A) Submucosal injection; (B) mucosal incision; (C) submucosal dissection; (D) myotomy; (E) mucosal closure.
Figure 2.
Figure 2.
Step-by-step of gastric per-oral endoscopic myotomy (G-POEM). (A) Submucosal injection; (B) mucosal incision; (C) pyloric muscle; (D) pyloromyotomy; (E) mucosal closure.
Figure 3.
Figure 3.
Step-by-step of Zenker’s diverticulum per-oral endoscopic myotomy (Z-POEM). Zenker’s diverticulum septum (A), submucosal injection over septum (B), mucosal incision over septum (C), isolated septum (D), septotomy (E), mucosal closure (F).
See this image and copyright information in PMC

References

    1. Draganov PV, Aihara H, Karasik MS. et al. Endoscopic submucosal dissection in north America: a large prospective multicenter study. Gastroenterology 2021;160:2317–27.e2. - PMC - PubMed
    1. Fleischmann C, Probst A, Ebigbo A. et al. Endoscopic submucosal dissection in Europe: results of 1000 neoplastic lesions from the German Endoscopic Submucosal Dissection Registry. Gastroenterology 2021;161:1168–78. - PubMed
    1. Tidehag V, Törnqvist B, Pekkari K. et al. Endoscopic submucosal dissection for removal of large colorectal neoplasias in an outpatient setting: a single-center series of 660 procedures in Sweden. Gastrointest Endosc 2022;96:101–7. - PubMed
    1. Bordillon P, Pioche M, Wallenhorst T. et al. Double-clip traction for colonic endoscopic submucosal dissection: a multicenter study of 599 consecutive cases (with video). Gastrointest Endosc 2021;94:333–43. - PubMed
    1. Khashab MA, Pasricha PJ.. Conquering the third space: challenges and opportunities for diagnostic and therapeutic endoscopy. Gastrointest Endosc 2013;77:146–8. - PubMed