Endoscopic submucosal dissection (ESD) for early gastric cancer was developed in the mid-1990s and by the 2000s had spread rapidly, first across Japan and then across other Asian countries that have high incidence of gastric cancer. The first high-frequency knife developed for use with ESD was the insulated tip (IT) knife. An improved IT knife 2 for the treatment of early gastric cancer followed, and later the IT knife nano was introduced for the treatment of esophageal and colon cancer; several other designs have subsequently been developed. Instruments and technique, including preprocedural examination, postprocedural course, and dealing with difficult gastric lesions, will be discussed.
KeywordsEndoscopic submucosal dissection Gastric cancer Early gastric cancer Endoscopic resection Electrosurgical unit
ESD Using an IT Knife. After the lesion is examined, the tip of the knife is used to mark the boundary. After sufficient submucosal injection, circumferential mucosal incision is made, followed by incision and dissection of the submucosa, and ending with hemostasis (MOV 71,924 kb)
ESD of a difficult lesion with submucosal fibrosis. A difficult case on the angle of the lesser curvature. The lesion is marked before injection of submucosal fluid cushion. The target area is then precut before circumferential mucosal incision. Due to difficult nature and location of lesion, most submucosal dissection is performed while in retroflexion for added stability. The scope is also held close to the target area and the knife is held firmly, to deal with the added difficulty of dissecting submucosal fibrosis (MOV 47,791 kb)
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