New Applications for Submucosal Tunneling in Third Space Endoscopy

Karanfilian, Briette; Kahaleh, Michel

doi:10.1097/mcg.0000000000001694

Cited by 3 publications

(5 citation statements)

References 99 publications

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“…Therefore, the pocket creation method or the tunneling method,as the minimal mucosal incision, might reduce the loss of injection agents. [12][13][14] Under such procedures, the injection performance of each knife might be improved.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, an excessive mucosal incision should be avoided in the actual endoscopic procedures to prevent the outflow of the injected agents. Therefore, the pocket creation method or the tunneling method, as the minimal mucosal incision, might reduce the loss of injection agents 12–14 . Under such procedures, the injection performance of each knife might be improved.…”

Section: Discussionmentioning

confidence: 99%

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Electrosurgical knife with the water‐jet function of tip‐type during endoscopic treatment injection

et al. 2022

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Objectives This study aimed to objectively evaluate the water‐jet‐functioned electrosurgical knife injection performances in a desktop experiment. Methods Five types of water‐jet‐functioned electrosurgical knives, including two injection styles of sheath‐type (A: DualKnife J, KD‐655L; B: FlushKnife, DK2620‐J‐B20S; C: Splash M‐Knife, DN‐D2718B; D: ISSEN, SN1650‐20) and tip‐type (E: ORISE ProKnife, M00519361) were evaluated. These knives were compared with an injection needle (Control: SuperGrip 25G) as a control. The injection speed under constant pressure and the injection efficiency for each knife against prepared porcine stomach mucosa were evaluated. The additional clear gel injections using an injection needle were observed using an indigo blue‐colored gel to evaluate the difference between the locations of water‐jet holes. Results Four types of knives, except for A, showed significantly higher water‐jet speeds (A: 0.79 ± 0.03 g/20 s, B: 2.56 ± 0.05 g/20 s, C: 3.09 ± 0.06 g/20 s, D: 2.86 ± 0.05 g/20 s, and E: 1.79 ± 0.03 g/20 s) compared to that of the control (1.21 ± 0.03 g/20 s). Meanwhile, significantly higher efficacy of injection was found in the tip‐type water‐jet function knife, second to the injection needle (Control: 37.2% ± 35.5%, A: 20.9% ± 20.2%, B: 1.1% ± 2.2%, C: 6.2% ± 12.6%, D: 12.5% ± 15.6%, and E: 33.3% ± 32.2%). An additional injection experiment revealed that the injection with a piercing tip into the gel could achieve sufficient additional injection inside the stacked clear gel. Conclusions The tip‐type water‐jet function electrosurgical knife is preferable for effective submucosal injection during endoscopic treatments.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Electrosurgical knife with the water‐jet function of tip‐type during endoscopic treatment injection

et al. 2022

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“…Open surgery has been associated with considerable morbidity, whereas the endoscopic approaches have a higher rate of symptom recurrence that is often attributed to incomplete septotomy [24]. Zenker per-oral endoscopic myotomy (ZPOEM) can help alleviate this issue through submucosal tunneling, which allows for complete exposure and dissection of the septum [25–27,28 ▪ ]. Specifically, ZPOEM enables the complete visualization of the posterior esophageal muscle, so it can be adequately divided to allow for proper drainage of the Zenker's diverticulum.…”

Section: Zenker Per-oral Endoscopic Myotomymentioning

confidence: 99%

Modern approaches to treating Zenker's diverticulum

Fair

Ward

2023

Current Opinion in Gastroenterology

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Purpose of review Zenker's diverticulum is the most common hypopharyngeal diverticulum. Patients with Zenker's diverticulum may require surgical treatment, which can be performed via an open surgical or endoscopic approach. A new endoscopic technique that is now being used for Zenker's diverticulum is Zenker Per Oral Endoscopic Myotomy (ZPOEM). ZPOEM has demonstrated promising results, and may have certain advantages over the other endoscopic treatments. The purpose of this review article is to evaluate the various surgical and endoscopic treatment options for Zenker's diverticulum, while specifically focusing on ZPOEM. Recent findings Endoscopic approaches have become the first-line therapy for Zenker's diverticulum, replacing the traditional open approach, because of the less invasive nature of the endoscopic procedures, improved rates of morbidity, and quicker recovery times. Recent studies evaluating ZPOEM have demonstrated that it is technically feasible and highly efficacious. In addition, it has a low rate of clinical recurrence and adverse events. When compared with other endoscopic techniques for treating Zenker's diverticulum, ZPOEM appears to have improved outcomes. Summary ZPOEM has been recently implemented in the algorithm of Zenker's diverticulum management. Further comparative and prospective studies focusing on long-term follow-up are still needed; however, ZPOEM appears to be an excellent option for patients suffering from Zenker's diverticulum.

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“…We read with great interest the article by Karanfilian and Kahaleh,1 in which third space endoscopy (TSE) can be used to treat gastrointestinal motility disorders and neoplasms throughout the digestive tract. This review mentioned the main TSE procedures and their applications, including peroral endoscopic myotomy, gastric peroral endoscopic myotomy, Zenker peroral endoscopic myotomy, submucosal tunneling for endoscopic resection, endoscopic submucosal tunnel dissection, peroral endoscopic tunneling for restoration of the esophagus, and per-rectal endoscopic myotomy 1…”

mentioning

confidence: 99%

“…This review mentioned the main TSE procedures and their applications, including peroral endoscopic myotomy, gastric peroral endoscopic myotomy, Zenker peroral endoscopic myotomy, submucosal tunneling for endoscopic resection, endoscopic submucosal tunnel dissection, peroral endoscopic tunneling for restoration of the esophagus, and per-rectal endoscopic myotomy. 1 …”

mentioning

confidence: 99%