Tawheed A, Ismail A, El-Tawansy A, Maurice K, Ali A, El-Fouly A, Madkour A. Third space endoscopy pulmonary complications and chylothorax post peroral endoscopic myotomy. World J Methodol 2025; 15(3): 102703 [DOI: 10.5662/wjm.v15.i3.102703]
Corresponding Author of This Article
Ahmed Tawheed, MD, PhD, Department of Endemic Medicine, Faculty of Medicine, Helwan University, Ain Helwan, Cairo 11795, Egypt. ahmed.tawhid@med.helwan.edu.eg
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
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: http://creativecommons.org/licenses/by-nc/4.0/
World J Methodol. Sep 20, 2025; 15(3): 102703 Published online Sep 20, 2025. doi: 10.5662/wjm.v15.i3.102703
Third space endoscopy pulmonary complications and chylothorax post peroral endoscopic myotomy
Ahmed Tawheed, Alaa Ismail, Ahmed El-Tawansy, Karim Maurice, Ahmed Ali, Amr El-Fouly, Ahmad Madkour
Ahmed Tawheed, Amr El-Fouly, Ahmad Madkour, Department of Endemic Medicine, Faculty of Medicine, Helwan University, Cairo 11795, Egypt
Alaa Ismail, Faculty of Medicine, Helwan University, Cairo 11795, Egypt
Ahmed El-Tawansy, Department of Anesthesia and Surgical Intensive Care, Helwan University, Cairo 11795, Egypt
Karim Maurice, Department of General and Laparoscopic Surgery, Cairo University, Cairo 12613, Egypt
Ahmed Ali, Department of Gastroenterology, Mansoura International Hospital, Al Mansurah 35516, Ad Daqahlīyah, Egypt
Co-first authors: Ahmed Tawheed and Alaa Ismail.
Author contributions: Tawheed A designed the overall concept and outline of the manuscript; Tawheed A and Ismail A wrote the manuscript, they contributed equally to this article, they are the co-first authors of this manuscript; El-Tawansy A revised manuscript and provided critical points from an anesthesia point of view; Ali A followed up on the patient’s medical plan; Maurice K provided the management plan for the case; El-Fouly A and Madkour A performed the per-oral endoscopic myotomy procedure for the patient; and all authors contributed to this article and approved the final version of the manuscript.
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: Ahmed Tawheed, MD, PhD, Department of Endemic Medicine, Faculty of Medicine, Helwan University, Ain Helwan, Cairo 11795, Egypt. ahmed.tawhid@med.helwan.edu.eg
Received: October 28, 2024 Revised: January 17, 2025 Accepted: January 23, 2025 Published online: September 20, 2025 Processing time: 131 Days and 6.1 Hours
Abstract
Third-space endoscopy (TSE) has emerged as an effective treatment modality for various gastrointestinal motility diseases and gastrointestinal tumors. TSE is based on the concept of working in the submucosa using a mucosal flap valve technique, which is the underlying premise for all TSE procedures; thus, some complications are shared across the spectrum of TSE procedures. Despite the high safety profiles of most TSE procedures, studies have reported various adverse events, including insufflation-related complications, bleeding, perforation, and infection. Although the occurrence rate of those complications is not very high, they sometimes result in critical conditions. No reports of chylous effusion following TSE procedures, particularly per-oral endoscopic myotomy, have been documented previously. We are presenting the first reported case of chylous pleural effusion after per-oral endoscopic myotomy. Additionally, we aim to present a comprehensive overview, discuss the existing data, and provide insights into pulmonary post-endoscopic complications in light of recent advancements in endoscopic procedures, especially TSE.
Core Tip: In this review, we discuss a case of post-per oral endoscopic myotomy chylothorax, focusing on its management, which was carried out with the assistance of other specialties through a multidisciplinary team including a cardiothoracic surgeon, nutritionist, anesthesiologist, and, of course, gastroenterologists. We also provide a brief review of the current known data in the literature regarding post-endoscopic pulmonary complications, especially in relation to third-space endoscopic procedures such as per oral endoscopic myotomy.
