Maintaining hemostasis during third-space endoscopy

Abstract

Third-space endoscopy is technically challenging and time consuming. Third-space procedures are associated with a significant risk of bleeding, both during and after the procedure (Fig. 1A). There are limited data and guidelines available on how to manage bleeding during per-oral endoscopic myotomy (POEM) and other forms of third-space endoscopy. The aim of this video is to demonstrate options for bleeding prophylaxis and Figure 1. A, Bleeding during third-space endoscopy. B, C, Coagulation with an endoscopic submucosal dissection knife. D, Hemostatic forceps to prevent bleeding. E, Hemostatic forceps to stop active bleeding. F, Hemostatic powder to obtain hemostasis.

New Applications for Submucosal Tunneling in Third Space Endoscopy

“…14 Hemostasis is maintained throughout the tunneling process, largely with the use of hot biopsy forceps or coagulation grasper. 14,15 The submucosal tunneling is aimed at the unique anatomic site involved in each procedure, and leads into the third step, which is the one that differentiates the procedures from one another. For instance, in GPOEM, the tunneling goes across the pylorus, which is followed by the main step of this procedure: pyloromyotomy.…”

“…The purpose of this is to begin to separate the mucosa from the muscularis, thereby facilitating the subsequent step, which is submucosal tunneling with an electrosurgical knife 14. Hemostasis is maintained throughout the tunneling process, largely with the use of hot biopsy forceps or coagulation grasper 14,15. The submucosal tunneling is aimed at the unique anatomic site involved in each procedure, and leads into the third step, which is the one that differentiates the procedures from one another.…”