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Endoscopic Submucosal Dissection (ESD)

  • Keiko NiimiEmail author
  • Mitsuhiro Fujishiro
  • Kazuhiko Koike
Chapter

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.

Keywords

Endoscopic submucosal dissection Colorectal tumor Indication criteria Clinical outcome Training system 

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

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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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Keiko Niimi
    • 1
    • 2
    Email author
  • Mitsuhiro Fujishiro
    • 1
    • 2
  • Kazuhiko Koike
    • 2
  1. 1.Department of Endoscopy and Endoscopic Surgery, Graduate School of MedicineThe University of TokyoTokyoJapan
  2. 2.Department of Gastroenterology, Graduate School of MedicineThe University of TokyoTokyoJapan

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