• Enqiang Linghu
  • Ningli Chai
  • Jiale Zou
  • Xiangyao Wang


The principle of digestive endoscopic tunnel technique (DETT) is to establish a tunnel between mucosa and muscularis propria and through the tunnel to perform endoscopic surgery of lesions from mucosa, muscularis propria and outside the digestive lumen. And most of all, the tunnel technique could well prevent the communication between the intra-luminal and the extra-luminal space by sealing the entry incision of the tunnel right after endoscopic surgery, thus the gas or fluid within the lumen was prevented from entering the extra-luminal space after surgery, which could ensure the endoscopic surgery free of perforation. Tunnel technique breaks the boundary between surgery and medicine since it would make many surgeons get involved in this field. Tunnel technique could be used to diagnose and treat diseases from the mucosa, muscularis propria and extra- luminal space. This chapter introduces the history and background, the principles and significance, indications and contraindications for DETT.


  1. 1.
    Linghu E. The creation and prospect of tunnel technique. Chin J Endosc Surg. 2011;4(5):1–2.Google Scholar
  2. 2.
    Linghu E. Endoscopic resection of gastrointestinal precancerous lesions and early cancer. Beijing: Chinese Medical Association Electronic Audio and Video Publishing House; 2009.Google Scholar
  3. 3.
    Inoue H, Minami H, Kobayashi Y, et al. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy. 2010;42(4):265–71.CrossRefGoogle Scholar
  4. 4.
    Linghu E, Zhang Y. Experimental study on the use of tunnel technique for the resection of esophageal muscularis. Chin J Laparosc Surg. 2011;(5):392–393.Google Scholar
  5. 5.
    Xu MD, Cai MY, Zhou PH, et al. Submucosal tunneling endoscopic resection: a new technique for treating upper GI submucosal tumors originating from the muscularis propria layer (with videos). Gastrointest Endosc. 2012;75(1):195–9.CrossRefGoogle Scholar
  6. 6.
    Chinese Medical Association Digestive Endoscopy Branch, Chinese Medical Doctor Association Endoscopic Physician Branch, Beijing Medical Association Digestive Endoscopy Branch, et al. Expert consensus on digestive endoscopic tunnel technique (2017, Beijing). Chin J Gastrointest Endosc. 2017;(4):145–158.Google Scholar
  7. 7.
    Chai N, Li H, Linghu E, et al. Consensus on the digestive endoscopic tunnel technique. World J Gastroentrol. 2019;25:744.CrossRefGoogle Scholar
  8. 8.
    Zhai Y, Linghu E, Li H. Double-tunnel endoscopic submucosal tunnel dissection for circumferential superficial esophageal neoplasms. Endoscopy. 2014;46(Suppl 1 UCTN):E204–5.PubMedGoogle Scholar
  9. 9.
    Linghu E, Feng X, Wang X, et al. Endoscopic submucosal tunnel dissection for large esophageal neoplastic lesions. Endoscopy. 2013;45(1):60–2.PubMedPubMedCentralGoogle Scholar
  10. 10.
    Linghu E. The basics and principles of endoscopic technology innovation from the development of endoscopic submucosal dissection and oral endoscopic myotomy. Chin J Dig Endosc. 2011;(11):603–604.Google Scholar
  11. 11.
    Ma X, Linghu E, Wang N, et al. Application of peroral endoscopic myotomy with short tunnel for Ling IIc type achalasia. Chin J Laparosc Surg. 2014;4.Google Scholar
  12. 12.
    Li H, Linghu E, Wang X, et al. Ling effects of ling classification of achalasia on complications of peroral endoscopic myotomy. Chin J Laparosc Surg. 2012;(5):348–351.Google Scholar
  13. 13.
    Chai N, Zhang X, Xiong Y, et al. Ling classification applied in the preoperative safety and effectiveness assessment of POEM. Surg Endosc. 2017;31(1):368–73.CrossRefGoogle Scholar
  14. 14.
    Benias PC, Khashab MA. Gastric peroral endoscopic pyloromyotomy therapy for refractory gastroparesis. Curr Treat Options Gastroenterol. 2017;15(4):637–47.CrossRefGoogle Scholar
  15. 15.
    Li Z, Gao Y, Chai N, et al. Effect of submucosal tunneling endoscopic resection for submucosal tumors at esophagogastric junction and risk factors for failure of en bloc resection. Surg Endosc. 2018;32(3):1326–35.CrossRefGoogle Scholar
  16. 16.
    Ma X, Linghu E, Li H, et al. Factors affecting the safety and efficacy of peroral endoscopic myotomy for achalasia. J South Med Univ. 2016;(7):892–897.Google Scholar
  17. 17.
    Linghu E. Interpretation of experts on digestive endoscopic tunnel technique (2017, Beijing). Chin J Gastrointest Endosc. 2017;(4):159–161.Google Scholar
  18. 18.
    Zhang W, Zhai Y, Chai N, et al. Endoscopic submucosal tunnel dissection and endoscopic submucosal dissection for large superficial esophageal squamous cell neoplasm: efficacy and safety study to guide future practice. Surg Endosc. 32:2814–21.Google Scholar
  19. 19.
    Zhai Y, Li H, Linghu E, et al. Endoscopic submucosal tunnel dissection for large superficial esophageal cell neoplasms. World J Gastroenterol. 22:435–45.Google Scholar
  20. 20.
    Linghu E. Therapeutics of digestive endoscopic tunnel technique. New York: Springer; 2013.Google Scholar
  21. 21.
    Choi HS, Chun HJ, Seo MH, et al. Endoscopic submucosal tunnel dissection salvage technique for ulcerative early gastric cancer. World J Gastroenterol. 20:9210–4.Google Scholar
  22. 22.
    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. 3:E195–201.Google Scholar
  23. 23.
    Inoue H, Sato H, Ikeda H, et al. Peroral endoscopic myotomy: a serious of 500 patients. J Am Coll Surg. 221:256–64.Google Scholar
  24. 24.
    Gonzalez JM, Vanbiervliet G, Vitton V, et al. First European human gastric peroral endoscopic myotomy, for treatment of refractory gastroparesis. Endoscopy. 47:E135–6.Google Scholar
  25. 25.
    Dacha S, Mekaroonkamol P, Li L, et al. Outcomes and quality-of-life assessment after gastric per-oral endoscopic pyloromyotomy (with video). Gastrointest Endosc. 86:282–9.Google Scholar
  26. 26.
    Du C, Chai N, Linghu E, et al. Submucosal tunneling endoscopic resection: an effective and safe therapy for upper gastrointestinal submucosal tumors originating from the muscularis propria layer. World J Gastroenterol. 25:245–57.Google Scholar
  27. 27.
    Du C, Chai N, Linghu E, et al. Treatment of cardial submucosal tumors originating from the muscularis propria layer: submucosal tunneling endoscopic resection versus endoscopic submucosal excavation. Surg Endosc. 32:4543–51.Google Scholar
  28. 28.
    Qin Z, Linghu E, Zhai Y, et al. Endoscopic transesophageal biopsy in the posterior mediastinum using submucosal tunneling technology and novel homemade instruments. Hepatogastroenterology. 61:1601–4.Google Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2020

Authors and Affiliations

  • Enqiang Linghu
    • 1
  • Ningli Chai
    • 1
  • Jiale Zou
    • 1
  • Xiangyao Wang
    • 1
  1. 1.Department of Gastroenterology and HepatologyFirst Medical Center of Chinese PLA General HospitalBeijingChina

Personalised recommendations