Résumé
La dissection sous-muqueuse endoscopique est un nouveau procédé de résection endoscopique des lésions néoplasiques gastrointestinales superficielles. C’est une technique remarquable car elle permet la résection de lésions relativement larges et difficiles voire impossibles à traiter par les techniques endoscopiques conventionnelles de résection muqueuse. Le Flex-knife est un instrument de DSE relativement sûr et maniable en raison de sa texture douce et souple. Néanmoins, la DSE est la plus pointue des techniques thérapeutiques endoscopiques d’autant que le côlon expose à des risques intrinsèques et à de grandes difficultés techniques. Pour cette raison, ce traitement impose une connaissance minutieuse et un apprentissage approprié. L’intervenant devrait s’en prendre à des lésions relativement faciles, de préférence au niveau gastrique, et ensuite graduellement, selon sa dextérité, s’attaquer à des cas plus difficiles tels des lésions colorectales.
Summary
Endoscopic submucosal dissection (ESD) is a new endoscopic technique for the resection of superficial gastrointestinal neoplasias. It is a wonderful technique since it enables the resection of relatively large and difficult lesions which are impossible to treat by conventional endoscopic mucosal resection techniques. Moreover the flex knife is a relatively safe and maneuverable device for colorectal ESD due to its soft and flexible nature. Although ESD is the most advanced technique of therapeutic endoscopy, the colon still presents intrinsic risks and high technical difficulties. Therefore thorough knowledge and training is indispensable in its treatment. The operator should address from relatively easy lesions, preferably from gastric lesion, to gradually step up according to his skill to relatively more difficult cases such as colorectal lesions.
Références
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Yahagi, N., Fujishiro, M. & Omata, M. Dissection sous-muqueuse endoscopique des lésions colorectales au moyen du bistouri Flex-knife. Acta Endosc 37, 665–672 (2007). https://doi.org/10.1007/BF02962003
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DOI: https://doi.org/10.1007/BF02962003
Mots-clés
- bistouri flexible
- dissection endoscopique sous-muqueuse (RES)
- Flex knife
- lésions colorectales
- LST-NG
- résection en bloc