Recent approach for preventing complications in upper gastrointestinal endoscopic submucosal dissection

Area of Science:

• Gastroenterology
• Minimally Invasive Surgery
• Endoscopy

Background:

• Endoscopic submucosal dissection (ESD) is a minimally invasive treatment for upper GI tumors.
• Complications, including intraoperative perforation and delayed bleeding, can occur during upper GI ESD.
• Duodenal ESD presents unique challenges with higher complication rates compared to esophageal and gastric ESD.

Purpose of the Study:

• To review and highlight methods for preventing major complications in upper gastrointestinal ESD.
• To discuss advancements in techniques and tools for safer ESD procedures.
• To identify current challenges and future directions in duodenal ESD.

Main Methods:

• Review of current literature and established techniques for complication prevention in ESD.
• Discussion of traction-assisted ESD for improved endoscopic view and reduced perforation.
• Introduction of the BEST-J score and vonoprazan therapy for managing delayed bleeding in gastric ESD.

Main Results:

• Traction-assisted ESD effectively reduces intraoperative perforation in esophageal and gastric ESD.
• The BEST-J score aids in predicting delayed bleeding risk in gastric ESD.
• Improved devices and techniques are decreasing complication rates in duodenal ESD, though challenges remain.

Conclusions:

• Preventing intraoperative perforation in ESD requires avoiding blind dissection and utilizing techniques like traction-assisted ESD.
• Managing delayed bleeding in gastric ESD can be addressed with specific scoring systems and pharmacological interventions.
• While duodenal ESD complications are decreasing, further standardization and research are necessary.