Third Space Endoscopic Therapies for Benign Motility Disorders: A Narrative Review

Area of Science:

• Gastroenterology and Endoscopy
• Minimally Invasive Surgery

Background:

• Third-space endoscopy (TSE) offers a minimally invasive approach to gastrointestinal motility disorders.
• Peroral endoscopic myotomy (POEM) has emerged as a primary treatment for achalasia, demonstrating high long-term success rates.

Purpose of the Study:

• To review the evidence, evolution, outcomes, adverse events, and management strategies for TSE procedures in benign motility disorders.
• To examine the current techniques, success rates, and long-term outcomes of TSE for motility disorders.

Main Methods:

• Literature review of TSE procedures for benign gastrointestinal motility disorders.
• Analysis of technique evolution, outcomes, and adverse events, including post-procedure gastroesophageal reflux (GER).

Main Results:

• POEM is established as first-line therapy for achalasia with >90% success at 7 years.
• TSE applications have expanded to include spastic esophageal disorders, diverticula, gastroparesis, and Hirschsprung's disease.
• Post-POEM GER affects 40%-55% of patients, remaining a key challenge with ongoing mitigation strategies.

Conclusions:

• TSE, particularly POEM, has transformed benign gastrointestinal motility disorder management from surgical to endoscopic approaches.
• Continuous technical refinement and GER mitigation strategies are expected to drive future advancements in the field.