 What are the recent advances in the influence of endoscopy? Till recently, gastroenterologists have been considered as doctors who mainly treat gas, dyscapsia, abdominal discomfort and diarrhea. But recently the scenarios changed a lot and gastroenterology feels as advanced immensely. And there's a sea load of change which has happened in the field of gastroenterology. Endoscopy was initially used as a tool to diagnose various gastrointestinal disorders like stomach cancer, colonic cancer and initially it was used to take biopsies and confirm diagnosis. Subsequently it moved to a rather small therapeutic procedures and small treatment was done through endoscopy. So this was stationary for almost 60 years and over this last decade there's been a lot of change or new breed of endoscopists has come or endoscopic procedures has come and which has helped immensely in the treatment of patients with gastrointestinal disorders. So what is third space endoscopy summer operation? The new breed of endoscopy is called as the submucosal operation so it's briefly called as sumo or the third space endoscopy. This is the new concept which has come. The procedures which are done inside the gut are called the first space or the second space procedures whereas one which is done inside the abdominal cavity is called as the first space. So gastrointestinal disorders recognize that there is a potential space between the layers of the intestine where you can go ahead and do some procedures inside the wall of the gut and even go outside the lumen of the intestine and do some procedures with safety and with the other things. So minimizing the difficulties of the patient and reducing the stay in the hospital and other inconveniences. So this is known as the submucosal operation or third space endoscopy. It's called as sumo also. It's also called as sumo. Is it a Japanese one? Yeah, this probably came up in first in the Japanese, Japanese brought that stuff, Chinese are doing a lot, now the European and the US countries are also catching up on this. So what is poem doctor? We are all endoscopy. Yeah, this is the latest innovation or one of those latest procedures where we do some of this treatment for a common condition called aklesha karya. Aklesha karya is a disease where the muscle of the foot pipe becomes tighter and the foot coefficients are not able to swallow food. So they haven't come with the difficulty in swallow. So conventionally it was treated with dilatation medicines which was not as effective. So a substitute or a common treatment for this was Heller's myotomy or a surgical procedure which has been replaced by this new technology which is called as paroral endoscopic myotomy. In this procedure the endoscopy is advanced through the wall of the endoscope and at the G-junction, at the junction of the foot pipe and the stomach the muscle is cut and the pressure, undue pressure on the muscles is released and thereby the patient is relieved of difficulty in swallow. So it's immensely handled in reducing the hospital stay, the cost of the procedure and it helps in, you know, it's a new technology for treatment of aklesha karya. So Doctor, how is it better than the conventional treatment for other patients? As I mentioned, the duration of the stay is longer, the procedure is shorter and the cost wise also compared to the other one, it's less invasive. The patient doesn't have external scar marks. It's all done through the natural orifice, it's done through the mouth. So the inconvenience of the patient is minimized and the cost is minimized, hospital stay is minimized. So what is the experience in Manipal? This has come to the field, as I said, the Japanese and the Chinese were doing a lot but now it is caught up in India. But Bangalore or Karnataka, we have not been doing it so far but in the last one year in Manipal, our own hospital, we have done more than 10 to 15 cases of such procedures and the initial experience has been very good. Patients have gone out in 24 to 48 hours, they got discharged and the relief has been very fantastic. Can early tumors be treated by this problem? So the small tumors which are in the early stages of the tumor, the same kind of extension of this technology can be used to remove the tumors from the gastrointestinal tract and instead of this advanced surgery, small simple procedures can cure this early tumors of the gastrointestinal tract. So what take home message would you like to give to the hospital? The field of gastrointology, especially the international endoscopy is advancing quite fast and many of those diseases which require advanced surgical procedures can be avoided by these new technologies which has come up. The selection is very important. Those cases which are ideal for this has to be picked up and one has to be very diligent in selecting these cases. Thanks a lot, Dr. Phukam, for coming over here and sharing your inputs about this talk. Thanks a lot, Dr. Phukam.