Principle of Digestive Endoscopic Tunnel Technique

(1)

Gastroenterology and hepatology, Chinese PLA General Hospital, Beijing, China, People’s Republic

Abstract

The principle of digestive endoscopic tunnel technique 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. In our practice, we found it much less time-consuming to use tunnel technique to dissect the mucosa from the muscularis propria than endoscopic submucosal dissection (ESD), which would make tunnel technique a very promising technique for submucosal dissection. 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.

1.1 Principle of Digestive Endoscopic Tunnel Technique

The principle of digestive endoscopic tunnel technique 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 (Figs. 1.1 and 1.2). 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. In our practice, we found it much less time-consuming to use tunnel technique to dissect the mucosa from the muscularis propria than endoscopic submucosal dissection (ESD), which would make tunnel technique a very promising technique for submucosal dissection [1, 2].

1.2 Significance of Digestive Endoscopic Tunnel Technique

Digestive endoscopic tunnel technique is a whole new technique that establish a third operational route other than the per-oral and the per-anal endoscopic route. Untill the advent of tunnel technique recently, the muscularis propria has rarely been involved during the endoscopic treatment. The layer of muscularis propria was a key factor to prevent perforation and entering of gas, fluid or bacteria into the extra-luminal space from within the digestive lumen when lesions of the mucosal layer were resected endoscopically. The application of tunnel technique deliberately realized safe incision of the muscularis propria and made it possible for endoscopists to treat some extra-luminal lesions, which were traditionally treated by percutaneous route. So, tunnel technique is to some extent an epoch-making minimally invasive surgery.

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