Advances in therapeutic endoscopy for upper GI diseases - From third space to robotics

In the past decades, advances in therapeutic endoscopy revolutionized the approached for treatment of upper GI diseases. The first performance of endoscopic submucosal dissection (ESD) for en-bloc resection of early gastric cancer inspired the development and improvement of various endoscopic procedures and technologies. The proposal of natural orifices transluminal endoscopic surgery (NOTES) in 2000 opened a new horizon of therapeutic endoscopy, directly leading to the development of Third Space Endoscopy. The success of Per Oral Endoscopic Myotomy (POEM) revolutionized the endoscopic approach for treatment of Achalasia. POEM became the gold standard treatment for Achalasia after the landmark randomized controlled trial confirming superiority of POEM against pneumatic dilatation. A portfolio of procedures were successfully developed basing on the concept of POEM, including Submucosal Tunnel Endoscopic Resection (STER) or Per Oral Endoscopic Tumor Resection (POET), Diverticulum-POEM for management of esophageal diverticulum, Zenker's POEM for treatment of Zenker's diverticulum, POETRE for Hirschsprung disease and Cricopharyngeal POEM for Parkinson's Dysphagia.

Despite the advances in Flexible Endoluminal Surgery in treatment of upper GI diseases, one of the major limitations is the development of therapeutic devices. Currently, therapeutic endoscopy is performed via instruments that passed through a single therapeutic channel which is in co-axial alignment with the imaging system. In future, advances in flexible robotics will enhance the development of therapeutic devices. We had successfully conducted clinical trial for a novel flexible robotic system for performance of colorectal ESD. In future, the innovative development of tissue approximation technologies will be enhanced through flexible robotics. Moreover, AI will be acting as co-pilot which further enhance the safety and efficiency of robotic ESD.