title: Investigating deeper: muscularis propria to natural orifice transluminal endoscopic surgery.
abstract: Submucosal endoscopy with a mucosal flap (SEMF) safety valve technique is a global concept in which the submucosa is a free working space for endoscopic interventions. A purposefully created intramural space provides an endoscopic access route to the deeper layers and into the extraluminal cavities. The mucosa overlying the intramural space is protective, reducing contamination during natural orifice transluminal endoscopic surgery (NOTES) procedures and providing a sealant flap to repair the entry point and the submucosal space. In addition to NOTES, SEMF enables endoscopic achalasia myotomy, histologic analysis of the muscularis propria, and submucosal tumor removal.
authors.affiliation: Department of Endoscopy, The Jikei University School of Medicine, 3-25-8 Nishi Shinbashi, Minato-ku, Tokyo 105-8461, Japan. Electronic address: kaz_sum@jikei.ac.jp.
authors.forename: Kazuki
authors.initials: K
authors.lastname: Sumiyama
authors.affiliation: Developmental Endoscopy Unit, Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, 200 First Street Southwest, Rochester, MN 55905, USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Gostout
authors.affiliation: Department of Endoscopy, The Jikei University School of Medicine, 3-25-8 Nishi Shinbashi, Minato-ku, Tokyo 105-8461, Japan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi Shinbashi, Minato-ku, Tokyo 105-8461, Japan.
authors.forename: Hisao
authors.initials: H
authors.lastname: Tajiri
mesh_terms: D004210:Dissection / Q000379:methods*; D004931:Esophageal Achalasia / Q000601:surgery; D049630:Esophageal Sphincter, Lower / Q000601:surgery; D004945:Esophagoscopy / Q000379:methods; D006801:Humans; D008866:Microsurgery / Q000379:methods*; D009092:Mucous Membrane / Q000601:surgery*; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*
keywords: Endomicroscopy; Enteric nerve system; Intramural endoscopy; Muscularis propria; Peroral endoscopic myotomy; Submucosal endoscopy with a mucosal flap safety valve technique; Submucosal endoscopy with mucosal resection; Submucosal tumor removal