Anaesthetic Considerations for Third-Space Endoscopy

Abstract

Newer mode of submucosal approach in endoscopy have opened up newer arenas in treatment of gastrointestinal (GI) diseases. Third space endoscopy (TSE) is an emerging area of interest in the treatment of GI diseases using this technique. This includes procedures like peroral endoscopic myotomy (POEM), Z POEM, gastric POEM, submucosal tunnelling endoscopic resection. Anaesthetic challenges faced are prolonged procedure duration, shared airway, aspiration of gastric contents, non-operating room anaesthesia, carbon dioxide insufflation and its complications. Vigilant monitoring of oxygenation, ventilation, end-tidal carbon dioxide, airway pressures, haemodynamics and close interaction between anaesthesiologist and endoscopist are essential for early recognition of insufflation-related complications. Proper standardization of protocols and training are needed for the anaesthesia personnel for prompt and safe delivery of anaesthesia.