ADVANCED TECHNIQUES ARE required to carry out therapeutic endoscopy including endoscopic submucosal dissection (ESD), peroral endoscopic myotomy (POEM), and peroral endoscopic tumor resection (POET). In order to achieve efficient procedures, a newly developed transparent distal attachment: super soft hood (Space adjuster; TOP, Tokyo, Japan) was designed (Fig. 1). It is made of silicon, has high flexibility, and can be attached to therapeutic endoscopes. This allows the endoscope to advance into and adjust to the narrow submucosal space stabilizing the endoscopic view and providing appropriate tension to the target tissue. When the fixed portion of the hood is attached to the endoscope more shallowly, thus making the protruding part of the hood longer, it easily adapts its shape to the space, and the target tissue can be cut with the tip of an electrosurgical knife. This hood may be applied to any therapeutic cases, including ESD, POEM, and POET. This hood stabilizes the view especially in cases where endoscopes tend to slide off with the previously available hard hood, as in spaces adjacent to stiff components such as firm submucosal lesions in POET cases or anatomical compressions (vertebral, tracheal, bronchial) in ESD/POEM/POET cases. It can also be effectively used in passing through the contraction of the lower esophageal sphincter in POEM cases. We present cases of ESD, POEM, and POET using this hood (Fig. 2; Videos S1, S2). We show that the hood adjusted its shape to the narrow spaces of the submucosal layer, as well as those comprising firm structures such as muscle layer or submucosal tumor. Overall, in using a highly flexible super soft hood, optimizing visualization of the submucosal layer and appropriate tissue tension can be easily obtained. This hood may aid in more efficient therapeutic endoscopy.

中文翻译：

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新开发的远端附件的用途：治疗性内窥镜检查中的超软罩（空间调节器）

需要先进的技术来进行治疗性内窥镜检查，包括内窥镜黏膜下剥离术 (ESD)、经口内窥镜肌切开术 (POEM) 和经口内镜下肿瘤切除术 (POET)。为了实现高效的手术，设计了一种新开发的透明远端附件：超软罩（空间调节器；TOP，东京，日本）（图 1）。它由硅制成，具有很高的柔韧性，可以连接到治疗性内窥镜上。这允许内窥镜前进并适应狭窄的粘膜下空间，稳定内窥镜视图并为目标组织提供适当的张力。当罩子的固定部分更浅地连接到内窥镜上时，从而使罩子的突出部分更长，它很容易适应空间的形状，并且可以用电刀的尖端切割目标组织。该头罩可应用于任何治疗案例，包括 ESD、POEM 和 POET。这种罩子可以稳定视野，尤其是在内窥镜容易与以前可用的硬罩子一起滑落的情况下，例如在与坚硬部件相邻的空间中，例如 POET 病例中的坚固粘膜下病变或 ESD/POEM 中的解剖压迫（椎骨、气管、支气管） /POET 案例。在POEM病例中也可有效用于通过下食管括约肌的收缩。我们展示了使用此罩的 ESD、POEM 和 POET 案例（图 2；视频 S1、S2）。我们表明，引擎盖将其形状调整为黏膜下层的狭窄空间，以及那些包括肌肉层或黏膜下肿瘤等坚固结构的空间。全面的，在使用高度灵活的超软罩时，可以轻松获得粘膜下层的优化可视化和适当的组织张力。该罩可有助于更有效的治疗性内窥镜检查。