Submucosal endoscopy: the present and future

Abstract

Submucosal endoscopy or third-space endoscopy utilizes the potential space between the mucosal and muscularis layers of the gastrointestinal tract to execute therapeutic interventions for various diseases. Over the last decade, endoscopic access to the submucosal space has revolutionized the field of therapeutic endoscopy. Submucosal endoscopy was originally used to perform endoscopic myotomy in patients with achalasia cardia, and its use has grown exponentially since. Currently, submucosal endoscopy is widely used to resect subepithelial tumors and to manage refractory gastroparesis and Zenker's diverticulum. While the utility of submucosal endoscopy has stood the test of time in esophageal motility disorders and subepithelial tumors, its durability remains to be established in conditions such as Zenker's diverticulum and refractory gastroparesis. Other emerging indications for submucosal endoscopy include esophageal epiphrenic diverticulum, Hirschsprung's disease, and esophageal strictures not amenable to conventional endoscopic treatment. The potential of submucosal endoscopy to provide easy and safe access to the mediastinum and peritoneal spaces may open doors to novel indications and rejuvenate the interest of endoscopists in natural orifice transluminal endoscopic surgery in the future. This review focuses on the current spectrum, recent updates, and future direction of submucosal endoscopy in the gastrointestinal tract.

An Esophageal Leiomyoma with Cystic Degeneration Mimicking a Malignant Neoplasm

“…In the past, surgical resection, such as thoracoscopic resection, was the primary treatment modality for esophageal leiomyomas located in the muscularis propria. However, endoscopic resection techniques, such as endoscopic submucosal dissection, endoscopic submucosal excavation, and submucosal tunneling endoscopic resection, have recently been introduced and have yielded high complete resection rates [13]. However, when a malignant SET is highly suspected, as in the present case, surgical resection is necessary to achieve satisfactory oncological outcomes.…”

Prevalence, natural progression, and clinical practices of upper gastrointestinal subepithelial lesions in Korea: a multicenter study

“…[17][18][19] SELs arising from the submucosa and muscularis propria can be sampled using tunnel biopsies (or deep-well biopsies), EUS-guided FNA/B, or advanced endoscopic techniques (unroofing or endoscopic resection). 2,[20][21][22][23][24][25] This study has some limitations. First, the prevalence rates varied among different institutions, suggesting that the incidence may depend on the endoscopist.…”

The role of cap-assisted endoscopy and its future implications

“…7). 26,27 In 2007, a new concept of natural orifice transluminal endoscopic surgery was proposed for peritoneoscopy through the stomach. 28 This technique was later applied as peroral endoscopic myotomy (POEM) for the treatment of achalasia.…”