Abstract
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.
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References
Ono H. Early gastric cancer: diagnosis, pathology, treatment techniques and treatment outcomes. Eur J Gastroenterol Hepatol. 2006;18(8):863–6.
Ono H, Kondo H, Gotoda T, Shirao K, Yamaguchi H, Saito D, et al. Endoscopic mucosal resection for treatment of early gastric cancer. Gut. 2001;48(2):225–9.
Ono H, Hasuike N, Inui T, Takizawa K, Ikehara H, Yamaguchi Y, et al. Usefulness of a novel electrosurgical knife, the insulation-tipped diathermic knife-2, for endoscopic submucosal dissection of early gastric cancer. Gastric Cancer. 2008;11(1):47–52.
Hotta K, Yamaguchi Y, Saito Y, Takao T, Ono H. Current opinions for endoscopic submucosal dissection for colorectal tumors from our experiences: indications, technical aspects and complications. Dig Endosc. 2012;24 Suppl 1:110–6.
Oyama T, Kikuchi Y. Aggressive endoscopic mucosal resection in the upper GI tract: hook knife EMR method. Min Invas Ther All Technol. 2002;11:291–5.
Yahagi N, Fujishiro M, Kakushima N, Kobayashi K, Hashimoto T, Oka M, et al. Endoscopic submucosal dissection for early gastric cancer using the tip of an electro-surgical snare (thin type). Dig Endosc. 2004;16:34–8.
Neuhaus H, Wirths K, Schenk M, Enderle MD, Schumacher B. Randomized controlled study of EMR versus endoscopic submucosal dissection with a water-jet hybrid-knife of esophageal lesions in a porcine model. Gastrointest Endosc. 2009;70(1):112–20.
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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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Ono, H. (2015). ESD Technique: Stomach. In: Fukami, N. (eds) Endoscopic Submucosal Dissection. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-2041-9_11
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DOI: https://doi.org/10.1007/978-1-4939-2041-9_11
Publisher Name: Springer, New York, NY
Print ISBN: 978-1-4939-2040-2
Online ISBN: 978-1-4939-2041-9
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