Clin Endosc.  2018 Jan;51(1):8-12. 10.5946/ce.2017.154.

Introduction to Endoscopic Submucosal Surgery

• Ko WJ
• Cho JY

• KMID: 2403626
• DOI: http://doi.org/10.5946/ce.2017.154

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.

Keyword

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

MeSH Terms

Diagnosis
Endoscopy
Gastrointestinal Diseases
Laparoscopy

Figure

• 

  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. 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. 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.

Reference

1. Swain P. A justification for NOTES--natural orifice translumenal endosurgery. Gastrointest Endosc. 2007; 65:514–516.

2. Kalloo AN, Singh VK, Jagannath SB, et al. Flexible transgastric peritoneoscopy: a novel approach to diagnostic and therapeutic interventions in the peritoneal cavity. Gastrointest Endosc. 2004; 60:114–117.

3. Sumiyama K, Tajiri H, Gostout CJ. Submucosal endoscopy with mucosal flap safety valve (SEMF) technique: a safe access method into the peritoneal cavity and mediastinum. Minim Invasive Ther Allied Technol. 2008; 17:365–369.

4. Yoshizumi F, Yasuda K, Kawaguchi K, Suzuki K, Shiraishi N, Kitano S. Submucosal tunneling using endoscopic submucosal dissection for peritoneal access and closure in natural orifice transluminal endoscopic surgery: a porcine survival study. Endoscopy. 2009; 41:707–711.

5. Inoue H, Minami H, Kobayashi Y, et al. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy. 2010; 42:265–271.

6. Stavropoulos SN, Desilets DJ, Fuchs KH, et al. Per-oral endoscopic myotomy white paper summary. Surg Endosc. 2014; 28:2005–2019.

7. Song GW, Ko WJ, Kim WH, Hahm KB, Hong SP, Cho JY. Peroral endoscopic myotomy for esophageal muscular ring. Endoscopy. 2015; 47 Suppl 1 UCTN:E387–E388.

8. Khashab MA, Stein E, Clarke JO, et al. Gastric peroral endoscopic myotomy for refractory gastroparesis: first human endoscopic pyloromyotomy (with video). Gastrointest Endosc. 2013; 78:764–768.

9. Chung H. Endoscopic pyloromyotomy: overview and early experience. In : In: International Digestive Endoscopy Network 2015 (IDEN 2015); 2015 Sep 12-13; Seoul, Korea. Seoul. Korean Society of Gastrointestinal Endoscopy. 2015. p. 143–146.

10. Kawai M, Peretta S, Burckhardt O, Dallemagne B, Marescaux J, Tanigawa N. Endoscopic pyloromyotomy: a new concept of minimally invasive surgery for pyloric stenosis. Endoscopy. 2012; 44:169–173.

11. Inoue H, Ikeda H, Hosoya T, et al. Submucosal endoscopic tumor resection for subepithelial tumors in the esophagus and cardia. Endoscopy. 2012; 44:225–230.

12. Gong W, Xiong Y, Zhi F, Liu S, Wang A, Jiang B. Preliminary experience of endoscopic submucosal tunnel dissection for upper gastrointestinal submucosal tumors. Endoscopy. 2012; 44:231–235.

13. Lu J, Zheng M, Jiao T, Wang Y, Lu X. Transcardiac tunneling technique for endoscopic submucosal dissection of gastric fundus tumors arising from the muscularis propria. Endoscopy. 2014; 46:888–892.

14. Gan T, Yang JL, Zhu LL, Wang YP, Yang L, Wu JC. Endoscopic submucosal multi-tunnel dissection for circumferential superficial esophageal neoplastic lesions (with videos). Gastrointest Endosc. 2016; 84:143–146.