Third-Space Endoscopy: Recent Updates

Third space or submucosal space is a potential space which on expansion allows the endoscopist to execute a multitude of therapeutic procedures for various gastrointestinal diseases like achalasia, subepithelial tumors, Zenker’s diverticulum, and refractory gastroparesis. Third space was first utili...

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Autores principales:	Zaheer Nabi, D Nageshwar Reddy
Formato:	article
Lenguaje:	EN
Publicado:	Thieme Medical and Scientific Publishers Pvt. Ltd. 2021
Materias:	submucosal endoscopy achalasia gastroparesis zenker’s diverticulum Diseases of the digestive system. Gastroenterology RC799-869
Acceso en línea:	https://doaj.org/article/e38ac58cdbc144489600d5fa8052617c
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spelling	oai:doaj.org-article:e38ac58cdbc144489600d5fa8052617c2021-11-25T01:57:14ZThird-Space Endoscopy: Recent Updates0976-50420976-505010.1055/s-0041-1739971https://doaj.org/article/e38ac58cdbc144489600d5fa8052617c2021-09-01T00:00:00Zhttp://www.thieme-connect.de/DOI/DOI?10.1055/s-0041-1739971https://doaj.org/toc/0976-5042https://doaj.org/toc/0976-5050Third space or submucosal space is a potential space which on expansion allows the endoscopist to execute a multitude of therapeutic procedures for various gastrointestinal diseases like achalasia, subepithelial tumors, Zenker’s diverticulum, and refractory gastroparesis. Third space was first utilized for performing endoscopic myotomy in cases with achalasia cardia about a decade ago. Since then, the field of submucosal endoscopy has witnessed an exponential growth. The present review focuses on recent advances in the field of third-space endoscopy. With regard to per-oral endoscopic myotomy (POEM) in achalasia cardia, several recent studies have evaluated the long-term outcomes of POEM, compared endoscopic myotomy with pneumatic dilatation (PD) and surgical myotomy, and evaluated the outcomes of short- versus long-esophageal myotomy. In addition, the utility of multiple dose antibiotic prophylaxis to prevent infections after POEM has been questioned. Overall, the results from these studies indicate that POEM is a durable treatment modality, equally effective to Heller’s myotomy and superior to PD. With regard to gastric-POEM (G-POEM), recent studies suggest only modest efficacy in cases with refractory gastroparesis. Therefore, quality studies are required to identify predictors of response to optimize the outcomes of G-POEM in these cases. Another third-space endoscopy procedure that has gained popularity is endoscopic division of septum in cases with esophageal diverticula including Zenker’s POEM and epiphrenic diverticula POEM (Z-POEM and D-POEM, respectively). The technique of diverticulotomy using the principles of submucosal endoscopy appears safe and effective in short term. Data on term outcomes are awaited and comparative trials with flexible endoscopic myotomy required. Per-rectal endoscopic myotomy (PREM) is the most recent addition to third space endoscopy procedures for the management of short-segment Hirschsprung’s disease. Limited data suggest that PREM may be a promising alternative surgery in these cases. However, quality studies with long-term follow-up are required to validate the outcomes of PREM.Zaheer NabiD Nageshwar ReddyThieme Medical and Scientific Publishers Pvt. Ltd.articlesubmucosal endoscopyachalasiagastroparesiszenker’s diverticulumDiseases of the digestive system. GastroenterologyRC799-869ENJournal of Digestive Endoscopy, Vol 12, Iss 03, Pp 160-166 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	submucosal endoscopy achalasia gastroparesis zenker’s diverticulum Diseases of the digestive system. Gastroenterology RC799-869
spellingShingle	submucosal endoscopy achalasia gastroparesis zenker’s diverticulum Diseases of the digestive system. Gastroenterology RC799-869 Zaheer Nabi D Nageshwar Reddy Third-Space Endoscopy: Recent Updates
description	Third space or submucosal space is a potential space which on expansion allows the endoscopist to execute a multitude of therapeutic procedures for various gastrointestinal diseases like achalasia, subepithelial tumors, Zenker’s diverticulum, and refractory gastroparesis. Third space was first utilized for performing endoscopic myotomy in cases with achalasia cardia about a decade ago. Since then, the field of submucosal endoscopy has witnessed an exponential growth. The present review focuses on recent advances in the field of third-space endoscopy. With regard to per-oral endoscopic myotomy (POEM) in achalasia cardia, several recent studies have evaluated the long-term outcomes of POEM, compared endoscopic myotomy with pneumatic dilatation (PD) and surgical myotomy, and evaluated the outcomes of short- versus long-esophageal myotomy. In addition, the utility of multiple dose antibiotic prophylaxis to prevent infections after POEM has been questioned. Overall, the results from these studies indicate that POEM is a durable treatment modality, equally effective to Heller’s myotomy and superior to PD. With regard to gastric-POEM (G-POEM), recent studies suggest only modest efficacy in cases with refractory gastroparesis. Therefore, quality studies are required to identify predictors of response to optimize the outcomes of G-POEM in these cases. Another third-space endoscopy procedure that has gained popularity is endoscopic division of septum in cases with esophageal diverticula including Zenker’s POEM and epiphrenic diverticula POEM (Z-POEM and D-POEM, respectively). The technique of diverticulotomy using the principles of submucosal endoscopy appears safe and effective in short term. Data on term outcomes are awaited and comparative trials with flexible endoscopic myotomy required. Per-rectal endoscopic myotomy (PREM) is the most recent addition to third space endoscopy procedures for the management of short-segment Hirschsprung’s disease. Limited data suggest that PREM may be a promising alternative surgery in these cases. However, quality studies with long-term follow-up are required to validate the outcomes of PREM.
format	article
author	Zaheer Nabi D Nageshwar Reddy
author_facet	Zaheer Nabi D Nageshwar Reddy
author_sort	Zaheer Nabi
title	Third-Space Endoscopy: Recent Updates
title_short	Third-Space Endoscopy: Recent Updates
title_full	Third-Space Endoscopy: Recent Updates
title_fullStr	Third-Space Endoscopy: Recent Updates
title_full_unstemmed	Third-Space Endoscopy: Recent Updates
title_sort	third-space endoscopy: recent updates
publisher	Thieme Medical and Scientific Publishers Pvt. Ltd.
publishDate	2021
url	https://doaj.org/article/e38ac58cdbc144489600d5fa8052617c
work_keys_str_mv	AT zaheernabi thirdspaceendoscopyrecentupdates AT dnageshwarreddy thirdspaceendoscopyrecentupdates
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Third-Space Endoscopy: Recent Updates

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