Abbreviations:CAST hood (calibrated, small-caliber-tip, transparent hood), ESD (endoscopic submucosal dissection), PCM (pocket-creation method), ST hood (small-caliber-tip, transparent hood)
Recurrent lesion of the rectum
Gastric lesion with ulceration
Elevated lesion suspected adenocarcinoma from Brunner’s gland of the descending part of the duodenum
- ・One can easily dive into the submucosal layer when the submucosal flap is made.
- ・The small volume inside the CAST hood makes it easy to replace saline solution in saline-immersion conditions.
- ・Accurately sized small pockets can be intentionally created in the normal mucosa on both sides of the severely fibrotic area in the submucosal pocket.
- ・In dissecting with saline immersion, the visibility of the endoscope is magnified 1.3 times, allowing accurate dissection.
- ・The field of vision is poor in air and visibility is extremely poor, especially in areas such as the wide lumen of the stomach.
- ・In the submucosal pocket, an appropriate field of view is maintained as long as the CAST hood is in contact with the muscular layer and submucosal layer on the lesion side; however, the larger the pocket, the larger the space and the poorer visibility of the endoscope.
- ・In the case of ESD with a wide cavity, after overcoming the section with the most severe fibrosis, if visibility worsens owing to the CAST hood, changing to a hood with good visibility, such as a cylindrical hood, will improve visibility.
- ・If the visibility of the endoscope is impaired because of air in a narrow lumen, such as the duodenum or large intestine, the visibility of the endoscope can be maintained by degassing the air in the intestine as much as possible to achieve saline immersion.
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If you would like to chat with an author of this article, you may contact Dr Nomura at [email protected]
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