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

  • Anastassios C. Manolakis
  • Haruhiro InoueEmail author
  • Akiko Ueno
  • Yuto Shimamura
Endoscopy (P Siersema, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Endoscopy


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.


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.


Third-space endoscopy Gastrointestinal tract Submucosal tunnel Per-oral endoscopic myotomy 



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

Compliance with Ethical Standards

Conflict of Interest

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.

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

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Anastassios C. Manolakis
    • 1
    • 2
  • Haruhiro Inoue
    • 2
    Email author
  • Akiko Ueno
    • 2
  • Yuto Shimamura
    • 2
  1. 1.Department of GastroenterologyUniversity Hospital of LarissaLarissaGreece
  2. 2.Digestive Diseases CenterShowa University Koto Toyosu HospitalTokyoJapan

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