November 28

Difficulty Swallowing? Discover How Third Space Endoscopy Can Help


It's mealtime, and instead of relishing your favorite culinary delights, you're apprehensive. Why? Because swallowing has become a challenge, a struggle that turns every bite into an ordeal. The medical term for this distressing condition is dysphagia. Whether chronic or sporadic, it can be more than just uncomfortable; it can significantly impact your quality of life. But the field of medical science never ceases to evolve. Today, we present you with an innovative procedure called Third Space Endoscopy, poised as a game changer in treating dysphagia. Offering less invasiveness non surgical endoscopic procedure with increased accuracy, this could be the solution to get you back to enjoying meals without dread or discomfort. Dive in and discover how Third Space Endoscopy could be a beacon of hope against swallowing difficulties.

Third space endoscopy is a procedure that can be used to address difficulty swallowing in certain cases. By utilizing techniques such as submucosal endoscopy and peroral endoscopic myotomy (POEM), it may enable the removal of obstructions, treatment of underlying conditions, and restoration of normal function in the gastrointestinal tract. Consulting with a gastroenterologist or an expert in the field would provide personalized advice regarding the suitability and potential benefits of third space endoscopy for addressing difficulty swallowing.

Understanding Third Space Endoscopy

When it comes to gastrointestinal endoscopy, traditional methods have their limitations. That's where third space endoscopy emerges as an innovative approach, offering new possibilities for various interventions. But what exactly is third space endoscopy?

Imagine your gastrointestinal tract as a series of layered tubes. The first layer is the innermost lining or mucosa, followed by the submucosa, and finally, the outermost muscular layer. Conventionally, endoscopic procedures focused on examining and treating issues within the first two layers. However, third-space endoscopy delves deeper into the submucosal space, allowing for more complex interventions.

A key technique utilized in third space endoscopy is submucosal endoscopy, which involves accessing the submucosal layer to perform therapeutic procedures. This can include peroral endoscopic myotomy (POEM) for achalasia, removal of subepithelial tumors, treatment of refractory gastroparesis, Zenker diverticulum treatment, and restoration of completely obstructed esophageal lumen.

For instance, peroral endoscopic myotomy (POEM) is a widely studied procedure in third space endoscopy for treating achalasia and nonachalasia spastic esophageal motility disorders. This technique involves raising a submucosal bleb to create a tunnel within the submucosa, performing myotomy to relieve muscle tightness, and then closing the mucosal incision.

In order to ensure safety during these procedures, a technique called SEMF (submucosal endoscopy with mucosal flap safety valve) is commonly employed. This technique allows secure closure of entry points into the second and third spaces and reduces the risk of complications.

Now that we have a basic understanding of third space endoscopy, let's explore the fundamentals and benefits of this innovative approach in greater detail.

  • Peroral Endoscopic Myotomy (POEM), a type of Third-Space Endoscopy procedure, has shown excellent clinical success rates in short-term and mid-term studies for treating achalasia, a condition that makes swallowing difficult.

  • Major adverse events related to Third-Space Endoscopy procedures are rather uncommon, making it a relatively safe choice for patients suffering from swallowing difficulties.

  • Emerging data as of 2023 suggests that POEM is not only effective for first-time treatments but can also be successful in cases where initial achalasia treatments have failed.

The Basics and Benefits

Third space endoscopy opens up a new frontier in gastrointestinal interventions by leveraging the submucosal space. This approach offers several key benefits compared to traditional endoscopic methods.

First and foremost, third space endoscopy allows for enhanced precision and access to challenging areas within the gastrointestinal tract. By going beyond the standard mucosal layer, physicians can target specific anatomical structures with greater accuracy. This opens up possibilities for more effective treatments and reduced complications.

Additionally, third space endoscopy can minimize the need for invasive surgical procedures. By utilizing advanced techniques such as submucosal tunneling, myotomy, or removal of subepithelial tumors, patients can potentially avoid traditional open surgeries. This results in reduced post-operative recovery time, decreased risk of complications, and improved patient outcomes.

Furthermore, third space endoscopy contributes to personalized medicine by tailoring interventions to individual patient needs. The ability to perform precise and targeted treatments based on specific diagnoses ensures that patients receive optimal care tailored to their unique conditions.

Think of it like a skilled artist using a fine brush instead of a broad stroke. Third space endoscopy provides physicians with a finer toolset to address complex issues within the gastrointestinal tract.

  • Third space endoscopy, a new frontier in gastrointestinal interventions, offers several key benefits compared to traditional endoscopic methods. It allows for enhanced precision and access to challenging areas within the gastrointestinal tract. By going beyond the standard mucosal layer, physicians can target specific anatomical structures with greater accuracy, leading to more effective treatments and reduced complications. Additionally, third space endoscopy can minimize the need for invasive surgical procedures by utilizing advanced techniques such as submucosal tunneling or myotomy. This results in reduced recovery time, decreased risk of complications, and improved patient outcomes. Moreover, third space endoscopy contributes to personalized medicine by tailoring interventions to individual patient needs. This newfound ability ensures that patients receive optimal care tailored to their unique conditions. Overall, third space endoscopy provides physicians with a finer toolset to address complex issues within the gastrointestinal tract.

Common Procedures

Third Space Endoscopy encompasses a wide range of procedures aimed at diagnosing and treating various conditions related to difficulty swallowing. Let's explore some of the common procedures performed using this technique:

  • Submucosal Endoscopy: This procedure involves accessing the submucosal space in the gastrointestinal tract to perform interventions. It has been used for diverse conditions such as peroral endoscopic myotomy (POEM) for achalasia, removal of subepithelial tumors, treatment of refractory gastroparesis, Zenker diverticulum, and restoration of completely obstructed esophageal lumen.

  • Peroral Endoscopic Myotomy (POEM): This procedure, widely studied in Third Space Endoscopy, is particularly effective in the treatment of achalasia and nonachalasia spastic esophageal motility disorders. The steps involved in  Esophageal POEM (E POEM) include submucosal bleb raising, mucosal incision, tunneling in the submucosa, myotomy, and closure of the mucosal incision. All done through a flexible endoscope. While short-term and mid-term results have shown excellent clinical success rates. Recently published five year study showed durable results in about 90% of the patients.

  • Removal of Subepithelial Tumors: Through Third Space Endoscopy techniques, gastroenterologists can safely remove subepithelial tumors located in the gastrointestinal tract. This minimally invasive approach significantly reduces the need for open surgery and offers a faster recovery time for patients.

  • Treatment of Refractory Gastroparesis: For individuals suffering from gastroparesis that is unresponsive to conventional treatments, Third Space Endoscopy offers alternative options such as gastric peroral endoscopic pyloromyotomy (G-POEM). G-POEM involves cutting the pyloric muscle to improve stomach emptying and alleviate symptoms.

  • Treatment of Zenker Diverticulum: Zenker diverticulum is a condition where there is an outpouching in the esophagus, leading to difficulty swallowing. Third Space Endoscopy offers a minimally invasive option called endoscopic Zenker peroral endoscopic myotomy (Z POEM) for the treatment of this condition by dividing the septum (Cricopharyngeal muscle) between the esophageal lumen and the diverticulum.

Now that we are familiar with some of the common procedures performed using Third Space Endoscopy, let's shift our focus to preparing for this procedure.

Preparing for Third Space Endoscopy

If you have been scheduled for Third Space Endoscopy, it is important to be adequately prepared to ensure a smooth procedure and minimize any potential risks or complications. Here are some steps you may need to follow and expectations to keep in mind:

  • Consultation with Your Gastroenterologist: Before your procedure, you will have an initial consultation with your gastroenterologist. This is an opportunity to discuss your symptoms, medical history, and any concerns you may have. Your doctor will evaluate whether Third Space Endoscopy is suitable for your condition and provide instructions specific to your case.

  • Preparation Instructions: Your gastroenterologist will likely provide detailed instructions on how to prepare for the procedure. This may include dietary restrictions (such as fasting prior to the procedure), guidelines on medication usage (such as stopping blood-thinning medications), and information on any required bowel preparation if necessary.

  • Arrangement for Transportation: Since Third Space Endoscopy typically involves sedation or anesthesia, it is important to arrange for someone to accompany you on the day of the procedure. They can provide transportation back home after the procedure since it may take some time for the effects of sedation to wear off completely.

  • Follow Pre-procedure Guidelines: It is crucial to strictly adhere to the pre-procedure guidelines provided by your healthcare provider. This may include avoiding certain foods, drinks, or medications that could interfere with the procedure or its results. Failure to follow these guidelines could result in the need for rescheduling.

  • Clear Communication: If you have any questions or concerns about the procedure or the preparation process, don't hesitate to communicate them with your healthcare team. Clear communication will help ensure that all necessary information is provided and any doubts are addressed.

Now that we have covered the steps and expectations involved in preparing for Third Space Endoscopy, let's dive into what you can expect during and after the procedure.

Steps and Expectations

Undergoing a third-space endoscopy procedure can be a significant step towards diagnosing and treating swallowing disorders or addressing other gastrointestinal conditions. To help you understand what to expect during this process, let's walk through the steps involved.

  • Preparation: Before the procedure, your healthcare provider will provide specific instructions on how to prepare. This may include fasting for a certain period of time, stopping certain medications or supplements, and discussing any allergies or medical conditions.

  • Anesthesia: Third-space endoscopy is typically performed under general anesthesia to ensure your comfort throughout the procedure. An anesthesiologist will administer the anesthesia, carefully monitoring your vital signs and adjusting the dosage as needed.

  • Endoscope Insertion: Once you are sedated, the physician will insert a thin, flexible tube called an endoscope into your mouth and guide it through the esophagus into the targeted area of the gastrointestinal tract. The endoscope is equipped with a light and camera that allows the physician to visualize the region in detail.

  • Evaluation and Treatment: Using advanced imaging techniques, such as high-definition video and magnification capabilities, the physician will carefully examine the area of interest within the gastrointestinal tract. 

  • Recovery: After the procedure is complete, you will be taken to a recovery area where medical professionals will monitor your condition until you wake up from anesthesia. You may experience some throat discomfort or mild side effects from the anesthesia, but these generally subside quickly. Currently all the patients undergoing third space procedure are routinely admitted for  overnight observation and the next day swallow study done to make sure everything is fine prior to drinking and discharge home.

  • Follow-up: Your healthcare provider will provide post-procedure instructions depending on your individual case. They may prescribe medication if necessary, or schedule follow-up appointments to monitor your progress.

Imagine Jane, who has been experiencing difficulty swallowing for several months, current diagnosis of Zenker diverticulum was made by various tests and she then she was scheduled for third-space endoscopy procedure (Z POEM). After following the preparation guidelines provided by her healthcare provider, she arrived at the hospital on the scheduled day. With the support of the skilled medical team, Jane was comfortably sedated, and the physician carefully evaluated her esophagus and performed Zenker peroral endoscopic myotomy. Jane's ability to swallow dramatically improved without any major complications.

Now that we have an understanding of the steps involved in a third-space endoscopy procedure, let's explore the essential equipment utilized during these advanced endoscopic procedures.

Essential Equipment for Third Space Endoscopy

Third-space endoscopy requires specialized equipment to ensure effective and precise examination and treatment of gastrointestinal conditions. Here are some essential tools commonly used during these procedures:

  • Endoscope: The endoscope is a flexible tube with a light source and camera attached at one end. It allows the physician to visualize internal structures of the GI tract and capture images or videos for evaluation or documentation.

  • Electrosurgical Unit (ESU): The ESU is a crucial tool that enables physicians to perform therapeutic interventions such as cutting, coagulating, or cauterizing tissues during third-space endoscopy procedures.

  • Endoscopic Submucosal Dissection (ESD) Kit: ESD is a technique used within third-space endoscopy to precisely remove precancerous lesions and early-stage cancers from the GI tract while preserving healthy tissue. The kit includes specialized instruments such as knives (few millimeter), forceps, and snares specifically designed for this purpose.

  • Coagulation Devices: Coagulation devices are used to achieve controlled tissue coagulation or hemostasis during third-space endoscopy procedures. They help stop bleeding by applying appropriate heat energy to the targeted area while minimizing damage to surrounding tissues.

Just like a surgeon's precision instruments, these specialized tools enable healthcare providers to navigate and address specific GI conditions effectively during third-space endoscopy procedures, leading to improved outcomes for patients.

With a clear understanding of the essential steps involved in a third-space endoscopy procedure and the equipment utilized, let's now explore who can benefit from these advanced endoscopic techniques.

Who is a Candidate for Third Space Endoscopy?

When it comes to addressing difficulty swallowing or other gastrointestinal issues, Third Space Endoscopy (TSE) has emerged as a valuable tool in the field of interventional gastroenterology. But who exactly would be considered an ideal candidate for this procedure? Let's explore the criteria that doctors use to determine suitability for TSE.

First and foremost, individuals experiencing difficulty swallowing or dysphagia may find themselves candidates for Third Space Endoscopy. Dysphagia can result from various conditions such as achalasia, esophageal motility disorders, Zenker diverticulum, or the presence of subepithelial tumors obstructing the normal passage of food. TSE offers minimally invasive solutions to address these underlying causes, providing relief and improved function to patients.

For instance, imagine a patient named Sarah who has been struggling with achalasia, a disorder affecting the smooth muscle function of her esophagus. This condition leads to difficulty swallowing and discomfort. In Sarah's case, her gastroenterologist recommends Third Space Endoscopy as a potential treatment option. By carrying out the procedure, they can safely navigate and manipulate the submucosal space, performing tasks such as peroral endoscopic myotomy (POEM) to relieve Sarah's symptoms.

In addition to addressing dysphagia caused by specific conditions, TSE may benefit individuals with refractory gastroparesis – a condition where the stomach muscles don't function properly, causing delayed emptying of food. By accessing the third space through endoscopy, doctors can potentially deliver targeted treatments or interventions tailored to manage gastroparesis effectively.

It's important to note that candidacy for Third Space Endoscopy is determined by a thorough evaluation from a gastroenterologist or an interventional endoscopist. Factors such as overall health, severity of the condition, presence of other comorbidities, and response to previous treatments will all be considered before recommending TSE as an appropriate course of action.

Being aware of potential candidacy for Third Space Endoscopy can empower individuals with dysphagia or related gastrointestinal issues to proactively engage with their healthcare providers and discuss potential treatment options. By exploring this innovative approach, patients may find significant improvements in their quality of life and regain proper swallowing function.

By understanding the criteria for candidacy and the role that Third Space Endoscopy plays in addressing difficulty swallowing, individuals can make more informed decisions about their healthcare journey. It's crucial to consult with a medical professional who specializes in interventional gastroenterology to determine if TSE is an appropriate treatment option for your specific condition.


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