Prevention and Treatment for Complications of Endoscopic Tunnel Technique

  • Enqiang Linghu


Endoscopic tunnel technique divides deliberately the wall of digestive tract into two-layer with the establishment of submucosal tunnel to ensure a safe barrier to prevent concerned serious complications in treatment of lesions from mucosa or muscularis propria. Even so, some complications might emerge inevitably. The most common complications are pneumatosis-related complications, including subcutaneous emphysema, mediastinal emphysema, pneumoperitoneum, and even pneumothorax. Mucosal perforation also happen occasionally, the incidence of which is 3.6–20 %. Hemorrhage, intraoperative or delayed, cannot be ignored in spite of its relatively low incidence. Gastroesophageal reflux is one of the most concerned complications of POEM, which influences the quality of life of the patients. Infection is one of most serious complications after operation, such as mediastinitis, peritonitis, pulmonary infection. Esophageal stricture is a major problem for patients with large esophageal mucosal lesions treated with tunnel technique, the incidence of which is closely related to length and circumferential area of lesions.


Muscularis Propria Esophageal Stricture Subcutaneous Emphysema Submucosal Tunnel Mediastinal Emphysema 
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  1. 1.
    Inoue H, Ikeda H, Hosoya T. Submucosal endoscopic tumor resection for subepithelial tumors in the esophagus and cardia. Endoscopy. 2012;44(3):225–30.PubMedCrossRefGoogle Scholar
  2. 2.
    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.PubMedCrossRefGoogle Scholar
  3. 3.
    Xu MD, Lu W, Li QL, et al. Application and evaluation of submucosal tunneling endoscopic resection of gastric submucosal tumors originating from the muscularis propria layer. Zhonghua Wei Chang Wai Ke Za Zhi. 2012;15(7):671–4.PubMedGoogle Scholar
  4. 4.
    Zhao ZF, Ma SR, Zhang N, et al. Endoscopic esophageal submucosal tunnel resection of gastric fundus-cardiac tumors originating from muscularis propria. Chin J Dig Endosc. 2012;29(9):506–9.Google Scholar
  5. 5.
    Swanström LL, Rieder E, Dunst CM. A stepwise approach and early clinical experience in peroral endoscopic myotomy for the treatment of achalasia and esophageal motility disorders. J Am Coll Surg. 2011;213(6):751–6.PubMedCrossRefGoogle Scholar
  6. 6.
    Costamagna G, Marchesea M, Familiari P, et al. Peroral endoscopic myotomy (POEM) for oesophageal achalasia: preliminary results in humans. Dig Liver Dis. 2012;44(10):827–32.PubMedCrossRefGoogle Scholar
  7. 7.
    Von Renteln D, Inoue H, Minami H, et al. Peroral endoscopic myotomy for the treatment of achalasia: a prospective single center study. Am J Gastroenterol. 2012;107(3):411–7.CrossRefGoogle Scholar
  8. 8.
    Zhou PH, Cai MY, Yao LQ, et al. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Chin J Dig Endosc. 2011;28(2):4–7.Google Scholar
  9. 9.
    Ren Z, Zhong Y, Zhou P, et al. Perioperative management and treatment for complications during and after peroral endoscopic myotomy (POEM) for esophageal achalasia (EA) (data from 119 cases). Surg Endosc. 2012;26(11):3267–72.PubMedCrossRefGoogle Scholar
  10. 10.
    Linghu E, Li H, Feng X, et al. Efficacy and safety of transverse entry incision during peroral endoscopic myotomy for achalasia. Chin J Dig Endosc. 2012;29(9):483–6.Google Scholar
  11. 11.
    Minami H, Isomoto H, Yamaguchi N, et al. Peroral endoscopic myotomy for esophageal achalasia: clinical impact of 28 cases. Dig Endosc. 2013 Apr 14. doi:  10.1111/den.12086. [Epub ahead of print].
  12. 12.
    Li H, Linghu E, Wang X. Fibrin sealant for closure of mucosal penetration at the cardia during peroral endoscopic myotomy (POEM). Endoscopy. 2012;44:E215–6.PubMedCrossRefGoogle Scholar
  13. 13.
    Inoue H, Tianle KM, Ikeda H, et al. Peroral endoscopic myotomy for esophageal achalasia: technique, indication, and outcomes. Thorac Surg Clin. 2011;21(4):519–25.PubMedCrossRefGoogle Scholar
  14. 14.
    Gao X, Shan H, Li Y, et al. Application of submucosal tunneling endoscopic resection for early esophageal cancer and precancerous lesions. J Clin Surg. 2012;20(7):491–2.Google Scholar
  15. 15.
    Ono S, Fujishiro M, Niimi K, et al. Long-term outcomes of endoscopic submucosal dissection for superficial esophageal squamous cell neoplasm. Gastroinest Endosc. 2009;70(5):860–6.CrossRefGoogle Scholar
  16. 16.
    Yamashina T, Ishihara R, Uedo N, et al. Safety and curative ability of endoscopic submucosal dissection for superficial esophageal cancers at least 50 mm in diameter. Dig Endosc. 2012;24(4):220–5.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2014

Authors and Affiliations

  • Enqiang Linghu
    • 1
  1. 1.Gastroenterology and hepatologyChinese PLA General HospitalBeijingChina, People’s Republic

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