Basic Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 7, 2019; 25(1): 85-94
Published online Jan 7, 2019. doi: 10.3748/wjg.v25.i1.85
Endoscopic trans-esophageal submucosal tunneling surgery: A new therapeutic approach for diseases located around the aorta ventralis
Ying Xiong, Qian-Qian Chen, Ning-Li Chai, Shun-Chang Jiao, En-Qiang Ling Hu
Ying Xiong, Qian-Qian Chen, Ning-Li Chai, En-Qiang Ling Hu, Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing 100853, China
Ying Xiong, Department of Gastroenterology and Hepatology, No. 1 Central Hospital of Baoding, Baoding 071000, Hebei Province, China
Shun-Chang Jiao, Department of Oncology, Chinese PLA General Hospital, Beijing 100853, China
Author contributions: Xiong Y and Chen QQ are both the first authors and contributed equally to this work. Ling Hu EQ and Jiao SC designed the research and are both corresponding authors ; Xiong Y performed the research; Chai NL contributed new reagents or analytic tools; Chen QQ analyzed the data; Chen QQ and Xiong Y wrote the paper.
Supported by Scientific Research Support Fund for Chinese PLA General Hospital, No. 2012FC-TSYS-3035.
Institutional animal care and use committee statement: This study was approved by the Institutional Animal Care and Use Committee of the Chinese PLA General Hospital, Beijng, China. Appropriate measures were taken to minimize pain or discomfort of the animals.
Conflict-of-interest statement: The authors declare that there is no conflict of interest regarding the publication of this article.
Data sharing statement: Technical appendix, statistical code, and dataset are available from the corresponding author at and
ARRIVE guidelines statement: The ARRIVE guidelines have been adopted.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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:
Corresponding author: En-Qiang Ling Hu, MD, PhD, Chief Doctor, Professor, Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing 100853, China.
Telephone: +86-10-55499405 Fax: +86-404-55499305
Received: May 27, 2018
Peer-review started: May 27, 2018
First decision: July 4, 2018
Revised: August 22, 2018
Accepted: October 5, 2018
Article in press: October 5, 2018
Published online: January 7, 2019
Research background

Surgical procedures are shifting paradigms in minimally invasive surgery nowadays, including natural orifice transluminal endoscopic surgery (NOTES), which is a technology of utilizing a flexible endoscope through a natural orifice to diagnose diseases and perform surgeries. The emergence of endoscopic tunnel technique makes the diseases which used to need surgical or laparoscopic surgical treatments enter into the endoscopic therapy.

Research motivation

We attempted to put forward a new approach using endoscopic tunneling techniques to perform NOTES, which was named endoscopic trans-esophageal submucosal tunneling surgery (EESTS).

Research objectives

To assess the efficiency of endoscopic trans-esophageal submucosal tunneling surgery technique for diseases located around the aorta ventralis.

Research methods

We simulated surgeries in a porcine model and to assess the efficiency of this new strategy.

Research results

One pig died from intraperitoneal hemorrhage after doing partial splenectomy, while the other pigs were alive after successfully operating all surgeries.

Research conclusions

We confirmed that EESTS is feasible and safe.

Research perspectives

EESTS by the submucosal tunneling technique to simulate surgeries for diseases located around the aorta ventralis is feasible, efficient, and relatively safe in a porcine model at least. Developing new endoscopic instruments suitable for the technique will be one of the future directions. However, the safety of profile has to be improved before adopting in a clinical setting.