Endoscopic Submucosal Dissection (ESD)
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.
KeywordsEndoscopic submucosal dissection Colorectal tumor Indication criteria Clinical outcome Training system
Endoscopic mucosal resection
Endoscopic submucosal dissection
Flexible spectral imaging color enhancement
Laterally spreading tumor
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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