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Ii) Unlike ESD, the gravity has fewer effects on ESTD for cardial lesions. During ESTD, the lateral tension in the tunnel can facilitate dissection. However, by use of gravity, bilateral resection can be performed from upper and low part respectively. (iii) The vessels in the cardia are rich, especially large ones. Therefore, the dissection should be near muscularis propria during tunnel creation. Meantime, the vessels should be preventively coagulated to keep clear operative view and decrease the operation time.
1936;6(1): 1–19. Chapter 6 Tunnel Technique for Digestive Mucosal Lesions Abstract The tunnel technique develops rapidly, and promising results have been shown in clinical studies and animal experiments. In this technique, one submucosal tunnel is created to provide working space for further endoscopic interventions, such as cutting the muscularis propria in the treatment of achalasia, removing gastrointestinal submucosal tumors, or even allowing access to the peritoneal and thoracic cavity for further interventions.
6 (a) The incision sealed by endoscopic clips. (b) No clips dropped 1 week after POEM. (c) Part of the clips had dropped 2 weeks after POEM. (d) Only 1 clip left 1 month after POEM. 5 4 Techniques in Tunnel Establishment Prevention of Infection The normal intact skin or mucosa is the most important barrier to infection. With mucosa incision and establishment of submucosal tunnel, endoscopic tunnel technique has broken through the conventional boundary of endoscopic techniques, and extended it to endoscopic surgical areas.