title: Submucosal tunneling techniques: current perspectives.
abstract: Advances in endoscopic submucosal dissection include a submucosal tunneling technique, involving the introduction of tunnels into the submucosa. These tunnels permit safer offset entry into the peritoneal cavity for natural orifice transluminal endoscopic surgery. Technical advantages include the visual identification of the layers of the gut, blood vessels, and subepithelial tumors. The creation of a mucosal flap that minimizes air and fluid leakage into the extraluminal cavity can enhance the safety and efficacy of surgery. This submucosal tunneling technique was adapted for esophageal myotomy, culminating in its application to patients with achalasia. This method, known as per oral endoscopic myotomy, has opened up the new discipline of submucosal endoscopic surgery. Other clinical applications of the submucosal tunneling technique include its use in the removal of gastrointestinal subepithelial tumors and endomicroscopy for the diagnosis of functional and motility disorders. This review suggests that the submucosal tunneling technique, involving a mucosal safety flap, can have potential values for future endoscopic developments.
authors.affiliation: Department of Gastroenterology and Neurology, Kagawa University, Miki-cho, Kita-Gun, Kagawa, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Kobara
authors.affiliation: Department of Gastroenterology and Neurology, Kagawa University, Miki-cho, Kita-Gun, Kagawa, Japan.
authors.forename: Hirohito
authors.initials: H
authors.lastname: Mori
authors.affiliation: Department of Pharmacology, Kagawa University, Miki-cho, Kita-Gun, Kagawa, Japan.
authors.forename: Kazi
authors.initials: K
authors.lastname: Rafiq
authors.affiliation: Department of Gastroenterology and Neurology, Kagawa University, Miki-cho, Kita-Gun, Kagawa, Japan.
authors.forename: Shintaro
authors.initials: S
authors.lastname: Fujihara
authors.affiliation: Department of Gastroenterology and Neurology, Kagawa University, Miki-cho, Kita-Gun, Kagawa, Japan.
authors.forename: Noriko
authors.initials: N
authors.lastname: Nishiyama
authors.affiliation: Department of Gastroenterology and Neurology, Kagawa University, Miki-cho, Kita-Gun, Kagawa, Japan.
authors.forename: Maki
authors.initials: M
authors.lastname: Ayaki
authors.affiliation: Department of Gastroenterology and Neurology, Kagawa University, Miki-cho, Kita-Gun, Kagawa, Japan.
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Yachida
authors.affiliation: Department of Gastroenterology and Neurology, Kagawa University, Miki-cho, Kita-Gun, Kagawa, Japan.
authors.forename: Tae
authors.initials: T
authors.lastname: Matsunaga
authors.affiliation: Department of Gastroenterology and Neurology, Kagawa University, Miki-cho, Kita-Gun, Kagawa, Japan.
authors.forename: Johji
authors.initials: J
authors.lastname: Tani
authors.affiliation: Department of Gastroenterology and Neurology, Kagawa University, Miki-cho, Kita-Gun, Kagawa, Japan.
authors.forename: Hisaaki
authors.initials: H
authors.lastname: Miyoshi
authors.affiliation: Department of Gastroenterology and Neurology, Kagawa University, Miki-cho, Kita-Gun, Kagawa, Japan.
authors.forename: Hirohito
authors.initials: H
authors.lastname: Yoneyama
authors.affiliation: Department of Gastroenterology and Neurology, Kagawa University, Miki-cho, Kita-Gun, Kagawa, Japan.
authors.forename: Asahiro
authors.initials: A
authors.lastname: Morishita
authors.affiliation: Department of Gastroenterology and Neurology, Kagawa University, Miki-cho, Kita-Gun, Kagawa, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Oryu
authors.affiliation: Life Science Research Center, Faculty of Medicine, Kagawa University, Miki-cho, Kita-Gun, Kagawa, Japan.
authors.forename: Hisakazu
authors.initials: H
authors.lastname: Iwama
authors.affiliation: Department of Gastroenterology and Neurology, Kagawa University, Miki-cho, Kita-Gun, Kagawa, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Masaki
keywords: functional and motility disorders; gastrointestinal subepithelial tumor; natural orifice transluminal endoscopic surgery; peroral endoscopic myotomy; submucosal endoscopy; submucosal tunneling method
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