Our challenges in advanced therapeutic endoscopy Young Award

Recent advances in endoscopic techniques have expanded its application to treat various gastrointestinal disorders. 1) Submucosal endoscopy and 2) deeper layer dissection are the two advancements we have developed. We introduce our novel techniques and summarize the clinical outcomes of these procedures.
1) Submucosal endoscopy: The era of submucosal endoscopy started with POEM. Between April 2015 and March 2022, more than 2500 cases of POEM were performed with a favorable outcome. Based on this, peroral endoscopic tumor resection (POET) has emerged, and over 50 cases were performed. These allowed us to revolutionalize the management of other disorders such as gastric POEM (G-POEM) and POEM for Zenker's diverticulum (Z-POEM). Our clinical outcomes revealed satisfactory safety and efficacy profile.
2) Deeper layer dissection: Recent refinements have allowed us to approach a deeper layer to resect subepithelial lesions and potentially invasive cancer. Endoscopic muscle layer dissection (EMD), endoscopic sub-serosal dissection (ESSD), and endoscopic full-thickness resection (EFTR) are performed based on the depth of the lesion. The main challenge we face during EFTR is the difficulty of the defect closure. Novel techniques such as Micro-ring and Loop9 closure methods are proposed to overcome this issue. Another challenge is the leakage of CO₂, which obscures the endoscopic view. The balloon occlusion method is one of the valuable techniques to prevent leakage.
By continuous refinements, difficulties are solved, thus establishing current techniques and paving the way for additional breakthroughs.