Consensus on the digestive endoscopic tunnel technique

Ning Li Chai, Hui Kai Li, En Qiang Linghu, Zhao Shen Li, Shu Tian Zhang, Yu Bao, Wei Gang Chen, Philip W.Y. Chiu, Tong Dang, Wei Gong, Shu Tang Han, Jian Yu Hao, Shui Xiang He, Bing Hu, Xiao Jun Huang, Yong Hui Huang, Zhen Dong Jin, Mouen A. Khashab, James Lau, Peng LiRui Li, De Liang Liu, Hai Feng Liu, Jun Liu, Xiao Gang Liu, Zhi Guo Liu, Ying Cai Ma, Gui Yong Peng, Long Rong, Wei Hong Sha, Pateek Sharma, Jian Qiu Sheng, Shui Sheng Shi, Dong Wan Seo, Si Yu Sun, Gui Qi Wang, Wen Wang, Qi Wu, Hong Xu, Mei Dong Xu, Ai Ming Yang, Fang Yao, Hong Gang Yu, Ping Hong Zhou, Bin Zhang, Xiao Feng Zhang, Ya Qi Zhai

Research output: Contribution to journalArticlepeer-review

Abstract

With the digestive endoscopic tunnel technique (DETT), many diseases that previously would have been treated by surgery are now endoscopically curable by establishing a submucosal tunnel between the mucosa and muscularis propria (MP). Through the tunnel, endoscopic diagnosis or treatment is performed for lesions in the mucosa, in the MP, and even outside the gastrointestinal (GI) tract. At present, the tunnel technique application range covers the following: (1) Treatment of lesions originating from the mucosal layer, e.g., endoscopic submucosal tunnel dissection for oesophageal large or circular early-stage cancer or precancerosis; (2) treatment of lesions from the MP layer, per-oral endoscopic myotomy, submucosal tunnelling endoscopic resection, etc.; and (3) diagnosis and treatment of lesions outside the GI tract, such as resection of lymph nodes and benign tumour excision in the mediastinum or abdominal cavity. With the increasing number of DETTs performed worldwide, endoscopic tunnel therapeutics, which is based on DETT, has been gradually developed and optimized. However, there is not yet an expert consensus on DETT to regulate its indications, contraindications, surgical procedure, and postoperative treatment. The International DETT Alliance signed up this consensus to standardize the procedures of DETT. In this consensus, we describe the definition, mechanism, and significance of DETT, prevention of infection and concepts of DETT-associated complications, methods to establish a submucosal tunnel, and application of DETT for lesions in the mucosa, in the MP and outside the GI tract (indications and contraindications, procedures, pre- and postoperative treatments, effectiveness, complications and treatments, and a comparison between DETT and other operations).

Original languageEnglish (US)
Pages (from-to)744-776
Number of pages33
JournalWorld Journal of Gastroenterology
Volume25
Issue number7
DOIs
StatePublished - 2019

Keywords

  • Digestive endoscopic tunnel technique
  • Endoscopic submucosal tunnel dissection
  • Gastrointestinal tract
  • Per-oral endoscopic myotomy
  • Submucosal tunnelling endoscopic resection

ASJC Scopus subject areas

  • Gastroenterology

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