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2007–2019: a “Third”-Space Odyssey in the Endoscopic Management of Gastrointestinal Tract Diseases

  • Endoscopy (P Siersema, Section Editor)
  • Published:
Current Treatment Options in Gastroenterology Aims and scope Submit manuscript

Abstract

Purpose of review

The main scope of this review article is to introduce readers to the innovative field of third-space endoscopy and offer a closer look at its history, milestones, and procedure spectrum while discussing ongoing and future challenges arising from its increasing adoption worldwide.

Recent findings

Over the past few years, third-space endoscopy has been utilized in various diagnostic and interventional procedures performed throughout the gastrointestinal tract: obliteration of Zenker’s diverticulum, myotomy for achalasia, gastroparesis or Hirschsprung’s disease, biopsy or removal of subepithelial tumors, stricture management, post-per-oral endoscopic myotomy endoscopic fundoplication, and mediastino-, thoraco-, and peritoneoscopy.

Summary

Third-space endoscopic interventions have revolutionized the management of esophageal motility disorders, gastroparesis, and gastrointestinal tract subepithelial tumors. Despite the high efficacy and safety of such interventions, some common (e.g., the high level of necessary endoscopic skill) and unique for each procedure (e.g., post-procedure gastroesophageal reflux or poor outcomes in patient subgroups) challenges still remain. Through a dedicated endoscopic training, a rigorous pre-procedure patient evaluation and selection, and the application of modified or new techniques, challenges can be overcome thus establishing existing procedures and paving the way for additional breakthroughs in the field of third-space endoscopy.

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Acknowledgements

Inoue H is an advisor of and receives educational grants from Olympus Corporation and Takeda Pharmaceutical Company, and is an advisor of Top Corporation.

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Authors and Affiliations

  1. Department of Gastroenterology, University Hospital of Larissa, Larissa, Greece

    Anastassios C. Manolakis MD, PhD

  2. Digestive Diseases Center, Showa University Koto Toyosu Hospital, 1-38 Toyosu, Koto-ku, Tokyo, 135-8577, Japan

    Anastassios C. Manolakis MD, PhD, Haruhiro Inoue MD, PhD, Akiko Ueno MD & Yuto Shimamura MD

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  1. Anastassios C. Manolakis MD, PhD
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  2. Haruhiro Inoue MD, PhD
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Correspondence to Haruhiro Inoue MD, PhD.

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Haruhiro Inoue reports grants from Olympus Corporation and other funds from Takeda Pharmaceutical Company and Top Corporation. Manolakis AC is a Hellenic Society of Gastroenterology grant holder. Yuto Shimamura declares that he has no conflict of interest. Akiko Ueno declares that she has no conflict of interest.

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Manolakis, A.C., Inoue, H., Ueno, A. et al. 2007–2019: a “Third”-Space Odyssey in the Endoscopic Management of Gastrointestinal Tract Diseases. Curr Treat Options Gastro 17, 202–220 (2019). https://doi.org/10.1007/s11938-019-00233-6

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