Shanbhag Akshay B, Thota Prashanthi N, Sanaka Madhusudhan R
Department of Gastroenterology, Cleveland Clinic Foundation, Cleveland, OH 44195, United States.
World J Gastrointest Endosc. 2020 Dec 16;12(12):521-531. doi: 10.4253/wjge.v12.i12.521.
Third space endoscopy or intramural endoscopy is based on the principle that the deeper layers of the gastrointestinal tract can be accessed by tunneling in the submucosal space and maintaining the integrity of the overlying mucosa. The era of third space endoscopy started with peroral endoscopic myotomy (POEM) for treatment of achalasia and has expanded to treat various other gastrointestinal disorders. The technique is also currently used for treatment of refractory gastroparesis, Zenker's diverticulum (ZD), resection of subepithelial tumors and early cancers of the gastrointestinal tract and Hirschsprung's disease (HD). These procedures are rapidly emerging as minimally invasive alternatives to conventional surgery. They are safe and effective with excellent outcomes. This review focuses on the evolution and current applications of third space endoscopy in various gastrointestinal disorders. Key points: (1) Third space or intramural endoscopy initially started with the POEM procedure for treatment of achalasia; (2) Advancements in procedural techniques have expanded its application to treat other gastrointestinal disorders such as refractory gastroparesis, ZD, HD, resection of subepithelial tumors and early gastrointestinal cancers; (3) These procedures are highly effective with excellent outcomes and low complication rates; and (4) Third space endoscopic procedures are rapidly emerging as minimally invasive alternatives to conventional surgery.
通过在黏膜下间隙进行隧道操作并保持覆盖黏膜的完整性，可以进入胃肠道的更深层。第三空间内镜检查时代始于用于治疗贲门失弛缓症的经口内镜下肌切开术（POEM），并已扩展到治疗各种其他胃肠道疾病。该技术目前还用于治疗难治性胃轻瘫、Zenker憩室（ZD）、切除上皮下肿瘤和胃肠道早期癌症以及先天性巨结肠（HD）。这些手术正迅速成为传统手术的微创替代方案。它们安全有效，效果极佳。本综述重点关注第三空间内镜检查在各种胃肠道疾病中的发展及当前应用。要点：（1）第三空间或壁内内镜检查最初始于用于治疗贲门失弛缓症的POEM手术；（2）手术技术的进步已将其应用扩展到治疗其他胃肠道疾病，如难治性胃轻瘫、ZD、HD、切除上皮下肿瘤和胃肠道早期癌症；（3）这些手术效果极佳，并发症发生率低；（4）第三空间内镜手术正迅速成为传统手术的微创替代方案。
