Abstract
Endoscopic submucosal dissection (ESD) is an ideal endoscopic resection technique for superficial neoplastic lesions in the GI tract in terms of confirmation of curative resection and very low local recurrence rate. However, it can be technically difficult and risky. In order to perform ESD safely and reliably, the factors contributing to potential difficulties should be recognized, and techniques to overcome these difficulties should be well understood and practiced.
In this chapter, the difficult factors of ESD are listed and techniques to overcome these difficulties are introduced. The pocket-creation method is a reliable ESD technique which can overcome most ESD difficulties.
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“Pocket-creation method” for ESD. Before mucosal incision at the proximal edge of the lesion, submucosal injection creates a fluid cushion under the lesion. Submucosal dissection is then performed to create a submucosal pocket. After completion of submucosal dissection under the tumor, incision and dissection of the bottom lateral edge of the lesion is made and then the distal edge. Completion of ESD is done by dissecting the remaining lateral edge and releasing the lesion (MP4 93,273 kb)
Pocket-creation method for a lesion with severe fibrosis. The pocket-creation method is useful for creating pockets on both sides of the fibrotic area, whereupon the muscle layer can be clearly recognized because it is pulled up at the fibrosis as a ridge. This ridge is dissected little by little until the fibrosis is dissected through and the ridge flattens, thus allowing the ESD procedure to continue as normal (MP4 102,964 kb)
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Yamamoto, H., Hayashi, Y., Sunada, K. (2015). How to Conquer Difficult ESD: Duodenum, Fibrosis, and More. In: Fukami, N. (eds) Endoscopic Submucosal Dissection. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-2041-9_13
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DOI: https://doi.org/10.1007/978-1-4939-2041-9_13
Publisher Name: Springer, New York, NY
Print ISBN: 978-1-4939-2040-2
Online ISBN: 978-1-4939-2041-9
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