Expanding Role of Third Space Endoscopy in the Management of Esophageal Diseases

Esophagus (PG Iyer, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Esophagus

Opinion statement

“Third space” endoscopy, also commonly referred as submucosal endoscopy, is founded on the principle that the deeper layers of the gastrointestinal (GI) tract can be accessed by tunneling in the submucosal space without compromising the integrity of the overlying mucosa. Peroral endoscopic myotomy (POEM), endoscopic submucosal dissection (ESD), and submucosal tunneling endoscopic resection (STER) are innovative techniques within the field of third space endoscopy in the management of esophageal disorders. POEM has become an accepted minimally invasive therapy for achalasia and related motility disorders with excellent short-term results, with early studies yielding similar efficacy to surgical myotomy and increased durability when compared to pneumatic balloon dilation (PBD). Data are needed to establish long-term outcomes with POEM, with particular interest on the incidence of gastroesophageal reflux, which appears to be higher than initially anticipated. ESD, a mature endoscopic resection technique in Asia, has recently gained traction in the West as a viable option for the management of early Barrett’s esophagus (BE) neoplasia. Compared to standard endoscopic mucosal resection (EMR), ESD allows the en bloc resection of lesions irrespective of size, which may facilitate histological interpretation and reduce recurrence rates. Large prospective randomized controlled trials are needed to validate the efficacy and safety of this technique and to further define its role in the endoscopic armamentarium in early BE neoplasia. STER is an attractive technique that theoretically permits the resection of subepithelial esophageal tumors (SETs) arising from the deeper GI layers. Initial studies from highly experienced endoscopic centers support its technical feasibility and safety, although these results should be interpreted with caution due to variability arising from small numbers and heterogeneity among studies. Overall, third space endoscopy is an expanding field within endoscopic therapeutics for the treatment of esophageal diseases. While initial results have been very promising, large prospective studies, long-term data, and structured training programs with the establishment of competency parameters are needed before third space endoscopy can be advocated outside of highly specialized centers.


Peroral endoscopic myotomy Endoscopic submucosal dissection Barrett’s esophagus Submucosal tunneling endoscopic resection Achalasia 


Compliance with ethical standards

Conflict of interest

Dennis Yang declares that he has no conflict of interest. Peter V. Draganov declares that he has no conflict of interest.

Human and animal rights and informed consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Kalloo AN, Singh VK, Jagannath SB, et al. Flexible transgastric peritoneaoscopy: a novel approach to diagnostic and therapeutic intervention in the peritoneal cavity. Gastrointest Endosc. 2004;60:114–7.CrossRefPubMedGoogle Scholar
  2. 2.
    ASGE; SAGES. ASGE/SAGES Working Group on natural orifice transluminal endoscopic surgery White Paper October 2005. Gastrointest Endosc. 2006;63:199–203.CrossRefGoogle Scholar
  3. 3.
    Lessons HRH. learned from traditional NOTES: a historical perspective. Gastrointest Endosc Clin N Am. 2016;26:221–7.CrossRefGoogle Scholar
  4. 4.
    Sumiyama K, Gostout CJ, Rajan E, et al. Transesophageal mediastinoscopy by submucosal endoscopy with mucosal flap safety valve technique. Gastrointest Endosc. 2007;65:679–83.CrossRefPubMedGoogle Scholar
  5. 5.
    Sumiyama K, Gostout CJ, Rajan E, et al. Transgastric cholecystectomy: transgastric accessibility to the gallbladder improved with the SEMF method and a novel multibending therapeutic endoscope. Gastrointest Endosc. 2007;65:679.CrossRefPubMedGoogle Scholar
  6. 6.
    Sumiyama K, Gostout CJ, Rajan E, et al. Submucosal endoscopy with mucosal flap safety valve. Gastrointest Endosc. 2007;65:688.CrossRefPubMedGoogle Scholar
  7. 7.
    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;17:365–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Pasricha PJ, Hawari R, Ahmed I, et al. Submucosal endoscopic esophageal myotomy: a novel experimental approach for the treatment of achalasia. Endoscopy. 2007;39:761–4.CrossRefPubMedGoogle Scholar
  9. 9.
    Inoue H, Minami H, Kobayashi Y, et al. Peroral endocopic myotomy (POEM) for esophageal achalasia. Endoscopy. 2010;42:265–71.CrossRefPubMedGoogle Scholar
  10. 10.
    Yang D, Draganov PV. Introducing POEM in your institution: the blueprint for launching a new program in the endoscopy suite. Practical Gastroenterology. 2016;32:52–6.Google Scholar
  11. 11.
    Yang D, Pannu D, Zhang Q, et al. Evaluation of anesthesia management, feasibility and efficacy of peroral endoscopic myotomy (POEM) for achalasia performed in the endoscopy unit. Endosc Int Open. 2015;3:E289–95.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Stavropoulos SN, Modavil RJ, Friedel D, Savides T. The International Per Oral Endoscopic Myotomy Survey (IPOEMS): a snapshot of the global POEM experience. Surg Endosc. 2013;27(9):3322–38.CrossRefPubMedGoogle Scholar
  13. 13.
    Li QL, Zhou PH. Perspective on peroral endoscopic myotomy for achalasia: Zhongshan experience. Gut Liver. 2015;9:152–8.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Onimaru M, Inoue H, Ikeda H, et al. Peroral endoscopic myotomy is a viable option for failed surgical esophagocardiomyotomy instead of redo surgical Heller myotomy: a single center prospective study. J Am Coll Surg. 2013;217:598–605.CrossRefPubMedGoogle Scholar
  15. 15.
    Khumbari V, Besharati S, Abdelgelil A, et al. Intraprocedural fluoroscopy to determine the extent of the cardiomyotomy during per-oral endoscopic myotomy (with video). Gastrointest Endosc 2015; 81: 1451–1456.Google Scholar
  16. 16.
    Grimes KL, Inoue H, Onimaru M, et al. Double-scope per oral endoscopic myotomy (POEM): a prospective randomized controlled trial. Surg Endosc. 2016;30:1344–51.CrossRefPubMedGoogle Scholar
  17. 17.
    Li C, Gong A, Zhang J, et al. Clinical outcomes and safety of partial full-thickness myotomy versus circular muscle myotomy in peroral endoscopic myotomy for achalasia patients. Gastroenterol Res Pract. 2017;2017:2,676,513.Google Scholar
  18. 18.
    Rider E, Swanstrom LL, Perretta S, et al. Intraoperative assessment of esophagogastric junction distensibility during per oral endoscopic myotomy (POEM) for esophageal motility disorders. Surg Endosc. 2013;27:400–5.CrossRefGoogle Scholar
  19. 19.
    Familiari P, Gigante G, Marchese M, et al. EndoFLIP system for the intraoperative evaluation of peroral endoscopic myotomy. United European Gastroenterol J. 2014;2:77–83.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Stavropoulous SN, Modayil R, Friedel D. Peroral endoscopic myotomy for the treatment of achalasia. Curr Opin Gastroenterol. 2015;31:430–40.CrossRefGoogle Scholar
  21. 21.
    Yang D, Draganov PV. Closing the gap in POEM. Endoscopy. 2013;45:677.CrossRefPubMedGoogle Scholar
  22. 22.
    Shiwaku H, Inoue H, Yamashita Y. Mucostomy closure using the endoloop/clips technique in a purse-string manner after an unsuccessful closure during peroral endoscopic myotomy. Dig Endosc. 2015;27:630–1.CrossRefPubMedGoogle Scholar
  23. 23.
    • Akintoye E, Kumar N, Obaitan I, et al. Peroral endoscopic myotomy: a meta-analysis. Endoscopy. 2016;48:1059–68. Recent comprehensive meta-analysis evaluating clinical outcomes of POEM for the treatment of achalasiaCrossRefPubMedGoogle Scholar
  24. 24.
    Barbieri LA, Hassan C, Rosati R, et al. Systematic review and meta-analysis: efficacy and safety of POEM for achalasia. United European Gastroenterol J. 2015;3:325–34.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Crespin OM, LWC L, Parmar A, et al. Safety and efficacy of POEM for treatment of achalasia: a systematic review of the literature. Surg Endosc. 2017;31:2187–201.CrossRefPubMedGoogle Scholar
  26. 26.
    Inoue H, Sato H, Ikeda H, et al. Per-oral endoscopic myotomy: a series of 500 patients. J Am Coll Surg. 2015;221:256–64.CrossRefPubMedGoogle Scholar
  27. 27.
    Patel K, Abbassi-Ghadi N, Markar S, et al. Peroral endoscopic myotomy for the treatment of esophageal achalasia: a systematic review and pooled analysis. Dis Esophagus. 2016;29:807–19.CrossRefPubMedGoogle Scholar
  28. 28.
    Pannu D, Yang D, Abbitt PL, et al. Prospective evaluation of CT esophagram findings after peroral endoscopic myotomy. Gastrointest Endosc. 2016;84:408–15.CrossRefPubMedGoogle Scholar
  29. 29.
    Hungness ES, Teitelbaum EN, Santos BF, et al. Comparison of perioperative outcomes between peroral esophageal myotomy (POEM) and laparoscopic Heller myotomy. J Gastrointest Surg. 2013;17:228–35.CrossRefPubMedGoogle Scholar
  30. 30.
    Bhayani NH, Kurian AA, Dunst CM, et al. A comparative study on comprehensive, objective outcomes of laparoscopic Heller myotomy with per-oral endoscopic myotomy (POEM) for achalasia. Ann Surg. 2014;259:1098–103.CrossRefPubMedGoogle Scholar
  31. 31.
    Chan SM, Wu JC, Teoh AY, et al. Comparison of early outcomes and quality of life after laparoscopic Heller’s cardiomyotomy to peroral endoscopic myotomy for treatment of achalasia. Dig Endosc. 2016;28:27–32.CrossRefPubMedGoogle Scholar
  32. 32.
    • Kumbhari V, Tieu AH, Onimaru M, et al. Peroral endoscopic myotomy (POEM) vs laparoscopic Heller myotomy (LHM) for the treatment of type III achalasia in 75 patients: a multicenter comparative study. Endosc Int Open 2015;3:E195–201. Multicenter retrospectively study comparing POEM vs LHM in patients with spastic type III achalasia.Google Scholar
  33. 33.
    Schlottmann F, Luckett DJ, Fine J, et al. Laparoscopic Heller myotomy versus peroral endoscopic myotomy (POEM) for achalasia: a systematic review and meta-analysis. Ann Surg 2017.
  34. 34.
    Awaiz A, Yunus RM, Khan S, et al. Systematic review and meta-analysis of perioperative outcomes of peroral endoscopic myotomy (POEM) and laparoscopic Heller myotomy (LHM) for achalasia. Surg Laparsoc Endosc Percutan Tech. 2017;27:123–31.CrossRefGoogle Scholar
  35. 35.
    Sanaka MR, Hayat U, Thota PN, et al. Efficacy of peroral endoscopic myotomy vs other achalasia treatments in improving esophageal function. World J Gastroenterol. 2016;22:4918–25.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Meng F, Li P, Wang Y, et al. Peroral endoscopic myotomy compared with pneumatic dilation for newly diagnosed achalasia. Surg Endosc 2017;31:4665–72.Google Scholar
  37. 37.
    •• Ponds FA, Fockens P, Nehaus H, et al. Peroral endoscopic myotomy (POEM) versus pneumatic dilation in therapy-naïve patients with achalasia: results of a randomized controlled trial. Gastroenterology. 2017;152:S139. Highly anticipated randomized controlled trial comparing POEM vs. pneumatic balloon dilation for the treatment of achalasiaCrossRefGoogle Scholar
  38. 38.
    Bredenoord AJ, Fox M, Kahrilas PJ, et al. Chicago classification criteria of esophageal motility disorders defined in high resolution esophageal pressure topography. Neurogastroenterol Motil. 2012;24:57–65.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    • Khashab MA, Messallam AA, Onimaru M, et al. International multi-center experience with peroral endoscopic myotomy for the treatment of spastic esophageal disorders refractory to medical therapy (with video). Gastrointest Endosc. 2015;81:1170–7. First multi-center study evaluating outcomes of POEM for the treatment of spastic esophageal disordersCrossRefPubMedGoogle Scholar
  40. 40.
    Khan MA, Kumbhari V, Ngamruengphong S, et al. Is POEM the answer for the management of spastic esophageal disorders? A systematic review and meta-analysis. Dig Dis Sci. 2017;62:35–44.CrossRefPubMedGoogle Scholar
  41. 41.
    Kandulski A, Fuchs KH, Weigt J, et al. Jackhammer esophagus: high-resolution manometry and therapeutic approach using peroral endoscopic myotomy (POEM). Dis Esophagus. 2016;29:695–6.CrossRefPubMedGoogle Scholar
  42. 42.
    Bechara R, Ikeda H, Inoue H. Peroral endoscopic myotomy for Jackhammer esophagus: to cut or not to cut the lower esophageal sphincter. Endosc Int Open. 2016;4:E585–8.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Moonen A, Annese V, Belmans A, et al. Long-term results of the European achalasia trial: a multicenter randomized controlled trial comparing pneumatic dilation versus laparoscopic Heller myotomy. Gut. 2016;65:732–9.CrossRefPubMedGoogle Scholar
  44. 44.
    Boeckxstaens GE, Annese V, des Varannes SB, et al. Pneumatic dilation versus laparoscopic Heller’s myotomy for idiopathic achalasia. N Engl J Med. 2011;3645:1807–16.CrossRefGoogle Scholar
  45. 45.
    Kumbhari V, Behary J, Szczesniak M, et al. Efficacy and safety of pneumatic dilation for achalasia in the treatment of post-myotomy symptom relapse. Am J Gastroenterol. 2013;108:1076–81.CrossRefPubMedGoogle Scholar
  46. 46.
    Pallati PK, Mittal SK. Operativeinterventions for failed Heller myotomy: a single institution experience. Am Surg. 2011;77:330–6.PubMedGoogle Scholar
  47. 47.
    Onimaru M, Inoue H, Ikeda H, et al. Peoral endoscopic myotomy is a viable option for failed surgical esophagocardiomyotomy instead of redo surgical Heller myotomy: a single center prospective study. J Am Coll Surg. 2013;217:598–605.CrossRefPubMedGoogle Scholar
  48. 48.
    Vigneswaran Y, Yetasook AK, Zhao JC, et al. Peroral endoscopic myotomy (POEM): feasible as reoperation following Heller myotomy. J Gastrointestinal Surg. 2014;18:1071–6.CrossRefGoogle Scholar
  49. 49.
    Zhou PH, Li QL, Yao LQ, et al. Peroral endoscopic remyotomy for failed Heller myotomy: a prospective single-center study. Endoscopy. 2013;45:161–6.CrossRefPubMedGoogle Scholar
  50. 50.
    • Ngamruengphong S, Inoue H, Ujiki MB, et al. Efficacy and safety of peroral endoscopic myotomy for treatment of achalasia after failed Heller myotomy. Clin Gastroenterol Hepatol 2017;15:1531–37. Multicenter study demonstrating high clinical response to POEM in patients after failed LHM but lower when compared to patients without prior surgery.Google Scholar
  51. 51.
    Van Hoeij FB, Ponds FA, Werner Y, et al. Management of recurrent symptoms after per-oral endoscopic myotomy in achalasia. Gastrointest Endosc 2018;87:95–101.Google Scholar
  52. 52.
    Maselli R, Inoue H, Misawa M. Peroral endoscopic myotomy (POEM) in a 3-year-old girl with severe growth retardation, achalasia, and Down syndrome. Endoscopy. 2012;44(Suppl 2 UCTN):E285–7.PubMedGoogle Scholar
  53. 53.
    Familiary P, Marchese M, Gigante G, et al. Peroral endoscopic myotomy for the treatment of achalasia in children. J Pediatr Gastroenterol Nutr. 2013;57:794–7.CrossRefGoogle Scholar
  54. 54.
    Chen WF, Li QL, Zhou PH, et al. Long-term outcomes of peroral endoscopic myotomy for achalasia in pediatric patients: a prospective, single-center study. Gastrointest Endosc. 2015;81:91–100.CrossRefPubMedGoogle Scholar
  55. 55.
    Tan Y, Zhu H, Li C, et al. Comparison of peroral endoscopic myotomy and endoscopic balloon dilation for primary treatment of pediatric achalasia. J Pediatr Surg. 2016;51:1613–8.CrossRefPubMedGoogle Scholar
  56. 56.
    Almogy G, Anthone GJ, Crookes PF. Achalasia in the context of morbid obesity: a rare but important association. Obes Surg. 2003;13:896–900.CrossRefPubMedGoogle Scholar
  57. 57.
    Koppman JS, Poggi L, Szomstein A, et al. Esophageal motility disorders in the morbidly obese population. Surg Endosc. 2007;21:761–4.CrossRefPubMedGoogle Scholar
  58. 58.
    Cote-Daigneault J, Leclerc P, Joubert J, et al. High prevalence of esophageal dysmotility in asymptomatic obese patients. Can J Gastroenterol Hepatol. 2014;28:311–4.CrossRefPubMedPubMedCentralGoogle Scholar
  59. 59.
    Yang D, Draganov PV. Peroral endoscopic myotom (POEM) for achalasia after Roux-en-Y gastric bypass. Endoscopy. 2014;46:E11–2.CrossRefPubMedGoogle Scholar
  60. 60.
    Von Renteln D, Inoue H, Minami H, et al. Perorla endoscopic myotomy for the treatment of achalasia: a prospective single center study. Am J Gastroenterol. 2012;107:411–7.CrossRefGoogle Scholar
  61. 61.
    Costagmagna G, Marchese M, Familiari P, et al. Peroral endoscopic myotomy (POEM) for oesophageal achalasia: preliminary results in humans. Dig Liver Dis. 2012;44:827–32.CrossRefGoogle Scholar
  62. 62.
    Kumbhari V, Familiari P, Bjerregaard NC, et al. Gastroesophageal reflux after peroral endoscopic myotomy: a multicenter case-control study. Endoscopy. 2017;49:634–42.CrossRefPubMedGoogle Scholar
  63. 63.
    Wagh MS, Yang D, Chavalitdhamrong D, Draganov PV. Per-oral endosopic tunneling for restoration of the esophagus (POETRE). Gastrointest Endosc. 2014;80:330.CrossRefPubMedGoogle Scholar
  64. 64.
    Wagh MS, Draganov PV. Per-oral endoscopic tunneling for restoration of the esophagus: a novel endoscopic submucosal dissection technique for therapy of complete esophageal obstruction. Gastrointest Endosc. 2017;85:722–7.CrossRefPubMedGoogle Scholar
  65. 65.
    Shimizu Y, Takahashi M, Yoshida T, et al. Endoscopic resection (endoscopic mucosal resection/endoscopic submucosal dissection) for superficial esophageal squamous cell carcinoma: current status of various techniques. Dig Endosc 2013;25 Suppl 1:13–19.Google Scholar
  66. 66.
    Edgren G, Adami HO, Weiderpass E, et al. A global assessment of the oesophageal adenocarcinoma epidemic. Gut. 2013;62:1406–14.CrossRefPubMedGoogle Scholar
  67. 67.
    Sikkema M, de Jonge PJ, Steyerberg EW, et al. Risk of esophageal adenocarcinoma and mortality in patients with Barrett’s esophagus: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2010;8:235–44.CrossRefPubMedGoogle Scholar
  68. 68.
    Desai TK, Krishnan K, Samala N, et al. the incidence of oesophageal adenocarcinoma in non-dysplastic Barett’s oesophagus: a meta-analysis. Gut. 2012;61:970–6.CrossRefPubMedGoogle Scholar
  69. 69.
    Hvid-Jensen F, Pedersen L, Drewes AM, et al. Incidence of adenocarcinoma among patients with Barrett’s esophagus. N Engl J Med. 2011;365:1375–83.CrossRefPubMedGoogle Scholar
  70. 70.
    Seewald S, Ang TL, Gotoda T, et al. Total endoscopic resection of Barrett esophagus. Endoscopy. 2008;40:1016–20.CrossRefPubMedGoogle Scholar
  71. 71.
    Draganov PV, Gotoda T, Chavalitdhamrong D, et al. Techniques of endoscopic submucosal dissection: application for the Western endoscopist? Gastrointest Endosc. 2013;78:677–88.CrossRefPubMedGoogle Scholar
  72. 72.
    Yang D, Coman RM, Kahaleh M, et al. Endoscopic submucosal dissection for Barrett’s early neoplasia: a multicenter study in the United States. Gastrointest Endosc 2017;86:600–7.Google Scholar
  73. 73.
    ASGE Technology Committee, Maple JT, Abu Dayyeh BK, et al. Endoscopic submucosal dissection. Gastrointest Endosc. 2015;81:1311–25.CrossRefGoogle Scholar
  74. 74.
    Aslan F, Seren AR, Akpinar Z, et al. The usage of overtube has a favorable effect on endoscopic submucosal dissection. Surg Endosc. 2015;29:2561–8.CrossRefPubMedGoogle Scholar
  75. 75.
    Nehaus H, Terheggen G, Rutz EM. Endoscopic submucosal dissection plus radiofrequency ablation of neoplastic Barrett’s esophagus. Endoscopy. 2012;44:1105–13.CrossRefGoogle Scholar
  76. 76.
    Hoteya S, Matsui A, Lizuka T, et al. Comparison of the clinicopathological characteristics and results of endoscopic submucosal dissection for esophagogastric junction and non-junction cancers. Digestion. 2013;87:29–33.CrossRefPubMedGoogle Scholar
  77. 77.
    Nagami Y, Machida H, Shiba M, et al. Clinical efficacy of endoscopic submucosal dissection for adenocarcinomas of the esophagogastric junction. Endosc Int Open. 2014;02:E15–20.CrossRefGoogle Scholar
  78. 78.
    Kagemoto K, Oka S, Tanaka S, et al. Clinical outcomes of endoscopic submucosal dissection for superficial Barrett’s adenocarcinoma. Gastrointest Endosc. 2014;80:239–45.CrossRefPubMedGoogle Scholar
  79. 79.
    Probst A, Aust D, Markl B, et al. Early esophageal cancer in Europe: endoscopic treatment by endoscopic submucosal dissection. Endoscopy. 2015;47:113–21.PubMedGoogle Scholar
  80. 80.
    Chevaux JB, Piessevaux H, Jouret-Mourin A, et al. Clinical outcome in patients treated with endoscopic submucosal dissection for superficial Barrett’s neoplasia. Endoscopy. 2015;47:103–12.CrossRefPubMedGoogle Scholar
  81. 81.
    Hobel S, Dautel P, Baumbach R, et al. Single center experience of endoscopic submucosal dissection (ESD) in early Barrett’s adenocarcinoma. Surg Endosc. 2015;29:1591–7.CrossRefPubMedGoogle Scholar
  82. 82.
    Barret M, Cao DT, Beuvon F, et al. Endosocpic submucosal dissection for early Barrett’s neoplasia. United Eur Gastroenterol J. 2016;4:207–15.CrossRefGoogle Scholar
  83. 83.
    •• Terheggen G, Horn EM, Vieth M, et al. A randomised trial of endoscopic submucosal dissection versus endoscopic mucosal resection for early Barrett’s neoplasia. Gut. 2016;0:1–11. Currently the only randomized controlled trial comparing ESD vs. EMR for the treatment of BE neoplasiaGoogle Scholar
  84. 84.
    Coman RM, Gotoda T, Forsmark CE, et al. Prospective evaluation of the clinical utility of endoscopic submucosal dissection (ESD) in patients with Barrett’s esophagus: a Western center experience. Endosc Int Open. 2016;4:E15–21.Google Scholar
  85. 85.
    • Subramaniam S, Chedgy F, Longcroft Wheaton G, et al. Complex early Barrett’s neoplasia at 3 Western centers: European Barrett’s Endoscopic Submucosal Dissection Trial (E-BEST). Gastrointest Endosc 2017; 86: 608–618 Recent large multicenter experience from Europe on ESD for the treatment of Barrett’s associated neoplasia.Google Scholar
  86. 86.
    Yang D, Zou F, Xiong S, Forde JJ, Draganov PV. Endoscopic submucosal dissection for the management of Barrett’s early neoplasia: a systematic review and meta-analysis. Gastrointest Endosc. 2017;85:AB409.CrossRefGoogle Scholar
  87. 87.
    Komeda Y, Bruno M, Koch AEMR. is not inferior to ESD for early Barrett’s and EGJ neoplasia: An extensive review on outcome, recurrence and complication rates. Endosc Int Open. 2014;2:E58–64.CrossRefPubMedPubMedCentralGoogle Scholar
  88. 88.
    Chennat J, Konda VJ, Ross AS, et al. Complete Barrett’s eradication endoscopic mucosal resection: an effective treatment modality for high-grade dysplasia and intramucosal carcinoma—an American single-center experience. Am J Gastroenterol. 2009;137:815–23.Google Scholar
  89. 89.
    Manner H, Pech O, Heldmann Y, et al. Efficacy, safety, and long-term results of endoscopic treatment for early stage adenocarcinoma of the esophagus with low-risk sm1 invasion. Clin Gastroenterol Hepatol. 2013;11:630–5.CrossRefPubMedGoogle Scholar
  90. 90.
    Participants in the Paris Workshop. The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon. Gastrointest Endosc 2003;58:S3–43.Google Scholar
  91. 91.
    Guo HM, Zhang XQ, Chen M, et al. Endoscopic submucosal dissection vs endoscopic mucosal resection for superficial esophageal cancer. World J Gastroenterol. 2014;20:5540–7.CrossRefPubMedPubMedCentralGoogle Scholar
  92. 92.
    Wani S, Abrams J, Edmundowicz SA, et al. Endoscopic mucosal resection results in change of histologic diagnosis in Barrett’s esophagus patients with visible and flat neoplasia: a multicenter cohort study. Dig Dis Sci. 2013;58:1703–9.CrossRefPubMedPubMedCentralGoogle Scholar
  93. 93.
    Inoue H, Ikeda H, Hosoya T, et al. Submucosal endoscopic tumor resection for subepithelial tumors in the esophagus and cardia. Endoscopy. 2012;44:225–30.CrossRefPubMedGoogle Scholar
  94. 94.
    Gong W, Xiong Y, Zhi F, et al. Preliminary experience of endoscopic submucosal tunnel dissection for upper gastrointestinal submucosal tumors. Endoscopy. 2012;44:231–5.CrossRefPubMedGoogle Scholar
  95. 95.
    Liu BR, Song JT, Kong LJ, et al. Tunneling endoscopic muscularis dissection for subepithelial tumors originating from the muscularis propria of the esophagus and gastric cardia. Surg Endosc. 2013;27:4354–9.CrossRefPubMedGoogle Scholar
  96. 96.
    Lu J, Zheng M, Jiao T, et al. Transcardiac tunneling technique for endoscopic submucosal dissection of gastric fundus tumors arising from the muscularis propria. Endoscopy. 2014;28:1971–7.CrossRefGoogle Scholar
  97. 97.
    Wang H, Tan Y, Zhou Y, et al. Submucosal tunneling endoscopic resection for upper gastrointestinal submucosal tumors originating from the muscularis propria layer. Eur J Gastroenterol Hepatol. 2015;27:776–80.CrossRefPubMedGoogle Scholar
  98. 98.
    Li QL, Chen WF, Zhang C, et al. Clinical impact of submucosal tunneling endoscopic resection for the treatment of gastric submucosal tumors originating from the muscularis propria layer (with video). Surg Endosc. 2015;29:3640–6.CrossRefPubMedGoogle Scholar
  99. 99.
    Jain D, Desai A, Mahmood E, et al. Submucosal tunneling endoscopic resection of upper gastrointestinal tract tumors arising from muscularis propria. Ann Gastroenterol. 2017;30:262–72.PubMedPubMedCentralGoogle Scholar
  100. 100.
    Li QY, Meng Y, Xu YY, et al. Comparison of endoscopic submucosal tunneling dissection and thoracoscopic enucleation for the treatment of esophageal submucosal tumors. Gastrointest Endosc 2017;86:485–491.Google Scholar

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Authors and Affiliations

  1. 1.Division of Gastroenterology, Hepatology and NutritionUniversity of FloridaGainesvilleUSA

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