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Structured Approach to Colonoscopy Technique Optimization: A Single-Center Experience with Novice Endoscopists

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Published on: July 11, 2025

Third-space endoscopy: Current techniques, clinical applications, and future directions.

Zaheer Nabi¹, Azimuddin Haza¹, Duvvur Nageshwar Reddy¹

¹Department of Gastroenterology, Asian Institute of Gastroenterology, India.

The Journal of International Medical Research

|July 6, 2026

Summary

This summary is machine-generated.

Third-space endoscopy creates a submucosal tunnel for minimally invasive gastrointestinal procedures. This technique offers a versatile platform for treating various conditions, evolving from per-oral endoscopic myotomy to diverse applications.

Keywords:

Third-space endoscopy achalasia gastroparesis per-oral endoscopic myotomy submucosal tunneling

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Area of Science:

Gastroenterology and Endoscopic Surgery
Minimally Invasive Therapeutic Endoscopy

Background:

Third-space endoscopy accesses the submucosal space between mucosal and muscularis propria layers.
Key principle involves creating a submucosal tunnel with a mucosal flap for safe therapeutic access.

Purpose of the Study:

To review the evolution, technical framework, clinical outcomes, and limitations of third-space endoscopy procedures.
To highlight the adaptability and minimally invasive nature of third-space endoscopy.

Main Methods:

Narrative review of third-space endoscopy techniques and their applications.
Discussion of procedures including per-oral endoscopic myotomy, tunneling resection, Zenker's per-oral endoscopic myotomy, and per-oral endoscopic myotomy for gastroparesis and diverticula.

Main Results:

Per-oral endoscopic myotomy has significantly impacted achalasia management and serves as a foundation for other applications.
Procedures like per-oral endoscopic myotomy and tunneling resection are established, while others like per-oral endoscopic myotomy for gastroparesis require further research on patient selection and durability.

Conclusions:

Third-space endoscopy provides a minimally invasive alternative to surgery for various gastrointestinal conditions.
Standardized principles enable broad adaptability across different disease phenotypes, despite ongoing questions in specific applications.