Third Space Endoscopy

Esophageal peroral endoscopic myotomy (E-POEM) is a minimally invasive third space endoscopic procedure that treats esophageal motility disorders.

Esophageal motility disorders are a group of illnesses that affect the esophagus and the way food is transferred from your mouth to your stomach. Some common ones include achalasia, jackhammer esophagus, diffuse esophageal spasm and esophagogastric junction outlet obstruction (EGJOO).

E-POEM is an alternative to surgical Heller myotomy for esophageal motility disorders, and it may be an option for people who have persistent or recurrent symptoms after a previous surgical procedure.

Evaluation of Esophageal Motility Disorders

Your physician may conduct a series of tests to diagnose your digestive problems. These tests may include:

• Standard upper endoscopy
• High-resolution esophageal manometry
• Radiographic tests (like a barium swallow)
• Endoflip

E-POEM is a good option for some patients but not everyone. Your physician may evaluate you in our clinic to discuss treatment options and determine if E-POEM may be right for you.

How Is the E-POEM Procedure Performed?

E-POEM is performed similarly to a standard upper endoscopy by an experienced advanced endoscopist who is specifically trained in third space endoscopy. The procedure is performed under general anesthesia and generally takes an hour to an hour and a half to complete.

Once you are under anesthesia, the physician uses a thin, flexible endoscope to navigate into your throat. Then, a superficial incision is made within the esophagus and a tunnel is created between the layers of the esophagus to reach the tight esophageal sphincter. A permanent cut (called a myotomy) of the sphincter muscle is then performed to help food pass into the stomach more easily.

After Your E-POEM Procedure

This procedure is routinely performed on an outpatient basis, although your physician may elect to admit you for an overnight stay in the hospital for monitoring. Nausea and pain medications are sometimes needed, but most patients have no symptoms 24 to 48 hours after the procedure. Your physician may order imaging tests to ensure the surgical area is intact before you can start a diet.

Going Back Home and to Work

After your procedure, you’ll complete a short course of antibiotics to prevent infection. Your diet will progress to a soft diet after the first three days following your E-POEM procedure, and then you can advance your oral intake as tolerated. You may resume all home medications unless otherwise instructed by your physician.

Gastric peroral endoscopic myotomy (G-POEM) is an innovative minimally invasive endoscopic technique to treat gastroparesis, a motility disorder that causes the stomach to empty slowly and food to not move properly into the small intestine.

Evaluation of Gastroparesis

Your physician may conduct a series of tests to diagnose your digestive problems. These tests may include:

• Standard upper endoscopy
• Radiographic tests
• Gastric emptying study
• EndoFLIP

G-POEM is a good option for some patients but not everyone. Your physician may evaluate you in our clinic to discuss treatment options and determine if G-POEM may be right for you.

How Is the G-POEM Procedure Performed?

G-POEM is performed in a similar fashion to a standard upper endoscopy by an experienced advanced endoscopist who is specifically trained in third space endoscopy. The procedure is performed under general anesthesia and generally takes an hour to an hour and a half to complete.

Once you are under anesthesia, the physician uses a thin, flexible endoscope to enter your throat and stomach. Then, a superficial incision is made within the stomach and a tunnel is created between the layers of the stomach to reach the pyloric sphincter. A permanent cut (called a pyloromyotomy) of the sphincter muscle is then performed to facilitate the easier passage of food into the small intestine.

After Your G-POEM Procedure

This procedure is routinely performed as an outpatient visit, although your physician may elect to admit you for an overnight stay in the hospital to monitor you. Nausea and pain medications are sometimes needed, but most patients have no symptoms 24 to 48 hours after the procedure. Your physician may order imaging tests to ensure the surgical area is intact before you can start a diet.

Going Back Home and to Work

You’ll complete a short course of antibiotics following your procedure to prevent infection. Your diet will progress to a soft diet after the first three days following your G-POEM procedure, and you can then advance your oral intake to a gastroparetic diet. You may resume all home medications unless otherwise instructed by your physician.

Flexible endoscopic techniques encompass an array of endoscopic procedures that treat symptomatic esophageal diverticula. These advanced endoscopic techniques are minimally invasive alternatives to conventional surgery.

What Is an Upper Esophageal Diverticulum?
Zenker’s refers to an outpouching or herniation of the esophagus, just below the upper esophageal sphincter.

Evaluation of an Upper Esophageal Diverticulum
Your physician may conduct a series of tests to diagnose your digestive problems. These tests may include a standard upper endoscopy or radiographic tests (barium swallow).
Flexible endoscopic intervention for your esophageal diverticulum is a good option for some patients but not everyone. Your physician may evaluate you in our clinic to discuss treatment options and determine if this may be the best choice for you.

How Is the Z-POEM Procedure Performed?
Treatment of Zenker’s diverticulum is performed in a similar fashion to a standard upper endoscopy by an experienced advanced endoscopist who is specifically trained in third space endoscopy. The procedure is performed under general anesthesia and generally takes half an hour to complete.
Once you are under anesthesia, the physician uses a thin, flexible endoscope to enter your throat. The physician will then use different types of electrosurgical knives to cut the cricopharyngeal muscle (septum) of the diverticulum.

After Your Z-POEM Procedure
Your physician may elect to admit you for an overnight stay in the hospital to monitor you. They may also order imaging tests to ensure the surgical area is intact before you can start a liquid diet.

Going Back Home and to Work
You will complete a short course of antibiotics following your procedure to prevent infection. Your diet will progress to a soft diet after the first three days following your procedure, and you can then advance your diet as tolerated. You may resume all home medications unless otherwise instructed by your physician.

ESD is a minimally invasive endoscopic procedure performed to remove lesions from the GI tract. As opposed to surgery, ESD permits the excision of GI lesions without requiring organ resection.

What Are Common Indications of ESD?

ESD indicators include:

• GI polyps in the esophagus, stomach, duodenum, colon and rectum
• GI-based cancers, including those arising from Barrett’s Esophagus and early tumors of the esophagus, stomach, colon or rectum with minimal or no risk of cancer spreading

How Is ESD Performed?

ESD is performed in a similar fashion to a standard upper endoscopy or colonoscopy by an experienced advanced endoscopist who is specifically trained in third space endoscopy. The procedure is performed under moderate or general anesthesia.

Once you’re under anesthesia, the physician inserts the endoscope through your mouth or anus, depending on the location of the lesion. Once the lesion is identified, the physician will use an electrosurgical knife to remove any precancerous or cancerous tissue from the GI wall until complete removal is confirmed endoscopically.

The resected specimen will be removed from the body through the endoscope and sent to a laboratory for examination. This last step may take several days before results are available.

After Your ESD Procedure

This procedure is routinely performed on an outpatient basis, although your physician may elect to admit you for an overnight stay in the hospital to monitor you.

Going Back Home and to Work

Antibiotics are generally not required following the ESD procedure. Individualized dietary and medication instructions based on the ESD site in the GI tract will be provided to you before you leave.