Establishment of Standard Submucosal Tunnel

  • Huikai Li
  • Zhenjuan Li
  • Ningli Chai
  • Enqiang Linghu


This chapter introduces the establishment of standard submucosal tunnel during DETT, including the standard operations, anatomic marks within the tunnel, new classifications of intraoperative bleeding and muscularis propria injury.


  1. 1.
    Linghu E. Therapeutics of digestive endoscopic tunnel technique (in Chinese). Beijing: Beijing Press; 2012. p. 38–55.Google Scholar
  2. 2.
    Linghu E. Therapeutics of digestive endoscopic tunnel technique. Berlin: Springer; 2014.CrossRefGoogle Scholar
  3. 3.
    Chai N, Li H, Linghu E, et al. Consensus on the digestive endoscopic tunnel technique. World J Gastroenterol. 2019;25(7):744–76.CrossRefGoogle Scholar
  4. 4.
    Linghu E. The establishment and prospect of endoscopic tunnel technique. Chin J Laparosc Surg. 2011;4:1–2.CrossRefGoogle Scholar
  5. 5.
    Linghu E, Wang N, Wang H. Application of inverse T incision in endoscopic submucosal tunnel dissection for cardia submucosal tumors in the muscularis propria: two cases report. Chin J Dig Endosc. 2015;32:483.Google Scholar
  6. 6.
    Linghu E, Feng X, Wang X, et al. Endoscopic submucosal tunnel dissection for large esophageal neoplastic lesions. Endoscopy. 2013;45:60–2.PubMedGoogle Scholar
  7. 7.
    Zhai Y, Li H, Linghu E. Endoscopic submucosal tunnel dissection for large superficial esophageal squamous cell neoplasms. World J Gastroenterol. 2016;22:435–45.CrossRefGoogle Scholar
  8. 8.
    Linghu E, Zhang X, Du H, et al. Innovated peroral endoscopic myotomy for achalasia: a case report. Chin J Gastrointest Endosc. 2014;1:40–1.Google Scholar
  9. 9.
    Linghu E, Xiong Y, Chai N, et al. The standard operation procedure of peroral endoscopic myotomy. Chin J Gastrointest Endosc. 2015;2:25–9.Google Scholar
  10. 10.
    Linghu E, Li H, Feng X. Efficacy and safety of transverse entry incision during peroral endoscopic myotomy for achalasia. Chin J Dig Endosc. 2012;29:438–41.Google Scholar
  11. 11.
    Inoue H, Minami H, Kobayashi Y, et al. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy. 2010;42(4):265–71.CrossRefGoogle Scholar
  12. 12.
    Linghu E, Ding H. Operational approach of peroral endoscopic myotomy. Chin J Gastrointest Endosc. 2014;1:55–9.Google Scholar
  13. 13.
    Linghu E. Therapeutics of digestive endoscopic tunnel technique. Beijing: Beijing Press; 2012. p. 38–55. (in Chinese).Google Scholar
  14. 14.
    Lerche W. The muscular coat of the esophagus and its defects. J Thorac Surg. 1936;6(1):1–19.Google Scholar
  15. 15.
    Zhongrong L. Muscular anatomy of cardia and its clinical significance in Heller’s myotomy. Chin J Clin Anat. 1996;14(2):129–31.Google Scholar
  16. 16.
    Liebermann-Meffert D. Surgical anatomy of the esophagogastric junction. Helv Chir Acta. 1981;47(6):667–77.PubMedGoogle Scholar
  17. 17.
    Chen T, Zhang C, Yao LQ, et al. Management of the complications of submucosal tunneling endoscopic resection for upper gastrointestinal submucosal tumors. Endoscopy. 2016;48:149–55.PubMedGoogle Scholar
  18. 18.
    Qumseya BJ, Wolfsen C, Wang Y, et al. Factors associated with increased bleeding post-endoscopic mucosal resection. J Dig Dis. 2013;14:140–6.CrossRefGoogle Scholar
  19. 19.
    Shi Xiangang LZ, Xu D, Che J, Jin Z, Zou D, Zhan X. Endoscopic submucosal dissection for early gastric cancers. Chin J Dig Endosc. 2008;25:574–7.Google Scholar
  20. 20.
    Jeon SW, Jung MK, Cho CM, et al. Predictors of immediate bleeding during endoscopic submucosal dissection in gastric lesions. Surg Endosc. 2009;23:1974–9.CrossRefGoogle Scholar
  21. 21.
    Jang JS, Choi SR, Graham DY, et al. Risk factors for immediate and delayed bleeding associated with endoscopic submucosal dissection of gastric neoplastic lesions. Scand J Gastroenterol. 2009;44:1370–6.CrossRefGoogle Scholar
  22. 22.
    Linghu EQ. New classifications of intraoperative bleeding and muscularis propria injury in endoscopic resection. Chin Med J. 2019;132:1856–8.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2020

Authors and Affiliations

  • Huikai Li
    • 1
  • Zhenjuan Li
    • 1
  • Ningli Chai
    • 1
  • Enqiang Linghu
    • 1
  1. 1.Department of Gastroenterology and HepatologyFirst Medical Center of Chinese PLA General HospitalBeijingChina

Personalised recommendations