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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Dec 16, 2025; 17(12): 111206
Published online Dec 16, 2025. doi: 10.4253/wjge.v17.i12.111206
Published online Dec 16, 2025. doi: 10.4253/wjge.v17.i12.111206
Mastering the third space: Innovations in intramural endoscopic surgery for gastrointestinal disorders
Gabriela Restrepo-Rodas, John Rodriguez, General Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi 00000, United Arab Emirates
Gabriela Restrepo-Rodas, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi 00000, United Arab Emirates
John Rodriguez, College of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH 44195, United States
Author contributions: All authors wrote the original draft, investigation, review-editing, and final approval.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: John Rodriguez, MD, FACS, General Surgery, Cleveland Clinic Abu Dhabi, 59 Hamouda Bin Ali Al Dhaheri St, Abu Dhabi 00000, United Arab Emirates.
Received: June 25, 2025
Revised: August 17, 2025
Accepted: November 11, 2025
Published online: December 16, 2025
Processing time: 174 Days and 5.2 Hours
Revised: August 17, 2025
Accepted: November 11, 2025
Published online: December 16, 2025
Processing time: 174 Days and 5.2 Hours
Core Tip
Core Tip: Third-space endoscopy has redefined the management of complex foregut disorders through techniques such as cricopharyngeal, esophageal, gastric, and Zenker’s myotomies. These procedures offer effective, less invasive alternatives to traditional surgery, with growing evidence of durable outcomes. This review outlines key technical refinements and clinical milestones that have expanded their indications and safety. Emerging innovations such as artificial intelligence models and precision-based techniques signal the next frontier. These advancements are expanding the scope and safety of third-space endoscopy, moving it closer to broader clinical adoption and personalized surgical care.