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Endoscopic submucosal dissection: How to be more efficient?

Thomas Lambin1,2, Jérôme Rivory1, Timothée Wallenhorst3

  • 1Gastroenterology and Endoscopy Unit, Pavilion L, Edouard Herriot Hospital, Lyon, France.

Endoscopy International Open
|November 18, 2021
PubMed
Summary
This summary is machine-generated.

Endoscopic submucosal dissection (ESD) offers en bloc resection for various lesion sizes. This review provides technical tips to improve efficiency and comfort during ESD procedures, minimizing complications.

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Area of Science:

  • Gastroenterology
  • Endoscopy
  • Surgical Techniques

Background:

  • Endoscopic submucosal dissection (ESD) enables en bloc resection with R0 margins, crucial for patient benefit.
  • Despite its advantages, ESD's technical complexity and longer procedure times compared to piecemeal mucosectomy are significant considerations.

Purpose of the Study:

  • To offer practical technical and strategical recommendations for optimizing ESD procedures.
  • The goal is to enhance procedural efficiency and endoscopist comfort during ESD.

Main Methods:

  • The review details key phases of ESD: injection, incision, submucosal access, and dissection.
  • It highlights common pitfalls in injection and incision, emphasizing proper techniques and tools.
  • Strategies like tunnel dissection, pocket creation, and traction systems are discussed for improved dissection.

Main Results:

  • Proper injection techniques and lifting solutions are vital for maintaining submucosal lift.
  • Careful mucosal incision and trimming facilitate submucosal access and R0 resection.
  • Traction systems are presented as essential for efficient dissection in the stomach and colon.

Conclusions:

  • Implementing these technical tips can streamline ESD procedures, making them more manageable.
  • Effective management of common complications like bleeding and perforation through endoscopic means is emphasized.