What is Third Space Endoscopy?
Third space endoscopy refers to a group of advanced endoscopic procedures that access the submucosal space (the "third space" between the mucosal lining and the muscle wall) to treat conditions that were previously only manageable with surgery. These techniques represent the cutting edge of interventional endoscopy.
Regional First
A/Prof Kostalas is the first endoscopist to offer third space endoscopy services on the Mid North Coast, providing patients with access to these advanced techniques without travelling to metropolitan centres.
Procedures
Endoscopic Full-Thickness Resection (EFTR)
EFTR allows the removal of lesions arising from the deeper layers of the GI wall, including the muscle layer. This is particularly useful for subepithelial tumours such as gastrointestinal stromal tumours (GISTs), leiomyomas, and other lesions that cannot be reached by conventional mucosal resection techniques.
Submucosal Tunnel Endoscopic Resection (STER)
STER uses a submucosal tunnel approach to access and remove subepithelial tumours arising from the muscularis propria layer of the oesophagus or stomach. The tunnel technique provides a safer approach by maintaining the integrity of the mucosal surface.
Z-POEM (Zenker's Per-Oral Endoscopic Myotomy)
Z-POEM is a minimally invasive endoscopic treatment for Zenker's diverticulum, a pouch that forms at the junction of the pharynx and oesophagus, causing difficulty swallowing, regurgitation, and aspiration. Z-POEM divides the cricopharyngeal muscle endoscopically, avoiding the need for open surgical repair.
G-POEM (Gastric Per-Oral Endoscopic Myotomy)
G-POEM is an endoscopic treatment for gastroparesis (delayed gastric emptying) that has not responded to medical therapy. The procedure involves creating a submucosal tunnel in the stomach and dividing the pyloric muscle to improve gastric emptying, avoiding the need for surgical pyloroplasty.
Videos
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Referral Information
If you have a patient who may benefit from third space endoscopy, please refer to A/Prof Kostalas for assessment. Referrals can be sent to reception@portmacquariegastro.com.au. Please include relevant imaging, endoscopy reports, and histopathology.