surgery.
As ESD grows in popularity, researchers have developed new types
of retraction devices to help with the removal of lesions and polyps
during ESD and EMR procedures. The devices, which fit over an
endoscope, have expandable cages to stretch the lumen of the esoph-
agus open to stabilize the scope and increase your doctor's ability to
see potential lesions during an endoscopy. They also have forceps that
can grasp, retract and manipulate tissue for better traction during an
ESD procedure, says Dr. Gross, who adds that the technology isn't
readily available yet.
4. Solve swallowing disorders
Peroral endoscopic myotomy (POEM), another relatively new and
increasingly popular procedure, helps treat such swallowing disorders
as achalasia, says Dr. Gross. The procedure works similarly to ESD in
many ways — namely that you cut into and tunnel through the sub-
mucosal layer — but it's focused on an area in the mid to lower
esophagus.
The doctor makes an incision into the wall of the mid esophagus and
moves the scope into that incision, traveling through the submucosa
until he's about 2 to 3 cm into the proximal section of the stomach. Once
there, he performs a myotomy, cutting the tense muscle fibers that are
causing achalasia.
"With POEM, you're cutting down deeper into the muscle to release
tension," says Dr. Sundararajan. "The only option [before POEM] was
surgery from the outside in."
POEM, introduced in Japan in 2008, hasn't been practiced in the
United States until recently.
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