Purpose of Review <p>Building a successful third space endoscopy program (TSE) requires alignment across multiple domains. The strategy should be consistent with the needs of the hospital and community at large. We hope to outline clinical questions and strategies for successfully building a TSE in a community hospital setting. </p> Recent Findings <p>The field of third space endoscopy has advanced beyond traditional ESD and POEM to include derivatives of POEM and submucosal tunneling techniques including submucosal tunneling endoscopic resection (STER).</p> Summary <p>There is a sparsity of data about third space endoscopy in American community hospitals. Focusing on proper training through mentorship, industry sponsored courses, appropriate indications can allow for a successful implementation of TSE program within a community hospital. Future research should focus on outcomes in TSE outside of academic institutions. </p>