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Endoscopic Submucosal Dissection (ESD)

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Advanced Colonoscopy

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Abstract

Endoscopic submucosal dissection (ESD) is a reliable method for en bloc resection of early-stage gastrointestinal tumors. However, colorectal ESD has a higher risk of complications and takes longer than endoscopic mucosal resection (EMR). To overcome its technical difficulty and high risk of complications, a refinement of specialized devices and equipment has been made, and training systems have been developed. In order to perform safe and effective ESD, preoperative assessment of the target lesion is indispensable. It is also important to consider the endoscopists’ skill level, the characteristics of the lesions, and their endoscopic manipulability.

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Abbreviations

CO2 :

Carbon dioxide

EMR:

Endoscopic mucosal resection

ER:

Endoscopic resection

ESD:

Endoscopic submucosal dissection

EUS:

Endoscopic ultrasonography

FICE:

Flexible spectral imaging color enhancement

GI:

Gastrointestinal

IEE:

Image-enhanced endoscopy

LST:

Laterally spreading tumor

NBI:

Narrow-band imaging

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Authors and Affiliations

  1. Department of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

    Keiko Niimi M.D., Ph.D. & Mitsuhiro Fujishiro M.D., Ph.D.

  2. Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

    Keiko Niimi M.D., Ph.D., Mitsuhiro Fujishiro M.D., Ph.D. & Kazuhiko Koike M.D., Ph.D.

Authors
  1. Keiko Niimi M.D., Ph.D.
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  2. Mitsuhiro Fujishiro M.D., Ph.D.
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  3. Kazuhiko Koike M.D., Ph.D.
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Corresponding author

Correspondence to Keiko Niimi M.D., Ph.D. .

Editor information

Editors and Affiliations

  1. New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York, USA

    Toyooki Sonoda

Electronic Supplementary Material

Below is the link to the electronic supplementary material.

Video 4.1 ESD of a flat 20 mm lesion type 0–IIa (lateral spreading type—nongranular) in the sigmoid colon: In this procedure, a submucosal injection using 0.2 % hyaluronic acid preparation is performed. The periphery of the lesion is incised starting from the anal side using DualKnife. The knife is then used to dissect the lesion in the submucosal plane. The knife is kept as parallel to the submucosa as possible to avoid perforation. A hemostatic forceps is used for precoagulation when needed. Mucosal incision of the oral side is then performed to complete the marginal mucosal cutting. Submucosal dissection is continuously performed from the anal side to the oral side with additional submucosal injection as needed. The ESD is successfully carried out using DualKnife (WMV 37021 kb).

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© 2014 Springer Science+Business Media New York

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Niimi, K., Fujishiro, M., Koike, K. (2014). Endoscopic Submucosal Dissection (ESD). In: Sonoda, T. (eds) Advanced Colonoscopy. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1584-2_4

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  • DOI: https://doi.org/10.1007/978-1-4939-1584-2_4

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-1583-5

  • Online ISBN: 978-1-4939-1584-2

  • eBook Packages: MedicineMedicine (R0)

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