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Create a Free AccountProcedures - Endoscopic submucosal dissection (ESD)
Successful endoscopic full-thickness resection of an exophytic subepithelial lesion with double scope traction technique
Endoscopic resection of an exophytic subepithelial lesion (SEL) in the stomach is challenging. Exophytic lesions are more amenable to surgical resection and are a relative contraindication for endoscopic resection. However, endoscopic resection of gastric SELs is now technically feasible with advancements in endoscopic techniques, such as peroral endoscopic tumor resection,1 endoscopic subserosal dissection,2 and endoscopic full-thickness resection.3 Secure closure of gastrointestinal (GI) wall defects is another technical challenge.Endoscopic submucosal dissection to treat squamous cell carcinoma in situ of the anal canal
The standard treatment for invasive squamous cell anal cancer is chemoradiation treatment. However, treatment options for high-grade dysplasia (squamous cell cancer in situ) are either surgical excision or topical treatment modalities. There are a few case reports, mainly from Japan, about resecting early squamous cell anal cancer (high-grade dysplasia/carcinoma in situ) by endoscopic submucosal dissection. We present a case series of 3 patients from a western hemisphere population with squamous carcinoma in situ of the anal canal resected with endoscopic submucosal dissection (ESD).Successful D-POEM after failed surgical myotomy and diverticulectomy
Peroral endoscopic myotomy with diverticulotomy (D-POEM) is feasible for management of achalasia with an epiphrenic diverticulum (ED).1-3 In a study of 14 patients with ED and underlying motility disorders with isolated lower esophageal sphincter (LES) POEM, all had postoperative Eckardt score improvement.4 Diverticulotomy is second-line treatment.4-7A successful case of endoscopic submucosal dissection using the water pressure method for early gastric cancer with severe fibrosis
The water pressure method (WPM) is an endoscopic submucosal dissection (ESD) technique that uses a water stream from the working channel of an endoscope.1-4 In addition to the floating force and magnification effect provided by underwater ESD, WPM allows us to flip up and get under the mucosal flap easily. Also, by vibrating the submucosa with the water stream, the submucosa and lateral edge that should be dissected can be precisely identified. Here, we report a case of gastric cancer with severe fibrosis due to previous ESD, which was successfully treated by ESD with WPM (Video 1, available online at www.giejournal.org ).Peroral endoscopic myotomy (POEM) for achalasia developing after vertical banded gastroplasty with asymptomatic gastro-gastric fistula
Peroral endoscopic myotomy (POEM) has revolutionized the treatment landscape for achalasia. Randomized trials and meta-analyses have shown that its efficacy is comparable to the traditional reference-standard surgical approach represented by laparoscopic Heller’s myotomy (LHM), with an outstanding safety profile1,2; higher postoperative reflux rates seem to be associated with POEM over LHM, owing to the absence of an antireflux procedure. POEM has consequently been proposed as a first-line option over LHM, which may carry higher perioperative and postoperative risk, for patients with previous abdominal surgery or obesity.Full-thickness resection: troubleshooting, tips, and tricks for success in the colorectum
Endoscopic resection is a well-established modality for the minimally invasive treatment of superficial lesions throughout the colon and rectum. Although EMR and endoscopic submucosal dissection (ESD) provide excellent results, they have limited efficacy in certain situations, such as deeper lesions and lesions with dense submucosal fibrosis.1,2 In these situations, endoscopic full-thickness resection (EFTR) provides an alternative endoscopic resection modality, potentially sparing patients from surgical resection.Gauze extension method for specimens resected by endoscopic submucosal dissection
Endoscopic submucosal dissection (ESD) is a standard and reliable procedure for resection of GI neoplasms. Although ESD allows en bloc resection of large GI neoplasms,1 ESD specimens tend to contract because of burning and scarring of the margins during ESD (Fig. 1). When preparing ESD specimens for pathologic examination, including evaluation of the margins, specimens should be extended and pinned on a fixing board as quickly as possible.2,3 However, in most cases, the normal marginal mucosa from ESD specimens is thin and fragile, especially from the colon.A specimen collection technique to ensure that the resected specimen is safely retrieved after duodenal ESD
In recent years, endoscopic submucosal dissection (ESD) has been applied for duodenal tumors.1-3 The advantage of en bloc excision in ESD is that it allows precise pathological examination.4 For this reason, it is important to ensure that the resected specimen is collected. However, there is no report on the collection method for duodenal specimens resected by ESD.Endoscopic full-thickness resection of well-differentiated T2 neuroendocrine tumors in the duodenal bulb: a case series
Endoscopic therapies have moved to the forefront in the removal of small, well-differentiated duodenal neuroendocrine tumors (NETs). Classic procedures used to address small tumors, especially those less than 1 cm in diameter, are banding without resection, ligation endoscopic mucosal resection, or endoscopic submucosal dissection. Endoscopic full-thickness resection (EFTR) is a procedure developed recently that allows for sealing off of the tissue surrounding the tumor before full-thickness removal.Hybrid endoscopic submucosal dissection for anal canal fibroma
An 83-year-old bedridden woman was referred for a suspected rectal polyp that frequently protruded from the anus when passing stools. Although the mass would reduce spontaneously, she experienced extreme discomfort, tenesmus, and occasional rectal bleeding. Ambulatory proctoscopy at the surgery department suggested a tumor in the lower rectum or anal canal.Endoscopic submucosal dissection of a symptomatic giant colonic lipoma: technical tips for resection and specimen retrieval
Colonic lipomas are rare, benign subepithelial tumors of the colon. They are usually asymptomatic and found incidentally during colonoscopy.1 Symptoms correlate with the size of the lipoma; as such, approximately 75% of patients with giant colonic lipomas (>4 cm) are symptomatic.2,3 Symptoms include abdominal pain, constipation, intussusception, or bowel obstruction. Endoscopic resection is preferred over surgery for symptomatic lipoma.3 Various endoscopic resection techniques have been described.Modified Zenker’s peroral endoscopic myotomy: a novel technique to improve access and depth of muscular dissection
A 73-year-old man presented with dysphagia and painless regurgitation of food contents, with a Dysphagia, Regurgitation, and Complications score of 7.1 A CT of the neck was performed (because of limited access to oral contrast during the SARS-CoV-2 pandemic), demonstrating a large Zenker’s diverticulum (Fig. 1). After extensive discussion, the patient preferred endoscopic treatment of his diverticulum because of his medical comorbidities.Endoscopic submucosal dissection using traction by a spring-and-loop with clip for a laterally spreading tumor in the inferior aspect of the cecum: a nonreferral center experience
Endoscopic submucosal dissection (ESD) has been widely accepted as a minimally invasive treatment for early colorectal neoplasms.1 However, cecal ESD remains a challenging treatment owing to the anatomical features of the cecum, such as the thin wall, and confrontation of the endoscope vertically with the muscular layer.Modified submucosal tunneling endoscopic resection for postcricoid esophageal subepithelial tumor
Submucosal tunneling endoscopic resection (STER) has been described as a technique for endoscopic resection of GI subepithelial tumors (SETs) arising from the muscularis propria layer1 and is an accepted treatment modality for these SETs.2 The standard STER technique involves submucosal elevation 3 to 5 cm proximal to the SET along its longitudinal axis, mucosotomy, submucosal tunneling, dissection of the SET within the tunnel, enucleation from the deep muscle layer, and specimen delivery followed by mucosal closure.Septal wall divides esophagus into double lumen: successful endoscopic septotomy
Intraluminal esophageal diverticulum is a rare condition identified by a collection of intraluminal barium with surrounding radiolucent halo on barium swallow.1-3 Historically, management has comprised proton pump inhibitor therapy, lifestyle modification, and esophageal dilation.1,2 Limited literature exists on the endoscopic management of this condition. Our case highlights the use of minimally invasive endoscopic techniques to manage intraluminal esophageal diverticulum.Successful endoscopic ultrasound-guided nasocavitary catheter drainage of abscess caused by delayed perforation after gastric endoscopic submucosal dissection
Delayed perforation after gastric endoscopic submucosal dissection (ESD) is a rare but serious adverse event often requiring emergency surgery.1,2 Here, we report the use of EUS-guided nasocavitary catheter drainage to treat an intra-abdominal abscess caused by delayed perforation after gastric ESD.Successful diagnosis and endoscopic submucosal dissection of a gastric gastrointestinal stromal tumor originating from the submucosal layer
A 77-year-old man was introduced to our institution because of a slow-growing gastric subepithelial tumor (SET). Esophagogastroduodenoscopy revealed an SET approximately 2 cm in size in the fundus of the stomach, which was covered with normal smooth mucosa (Fig. 1A). EUS using a 20-MHz miniature probe (UM-3R; Olympus, Tokyo, Japan) showed a uniform hypoechoic lesion, 21.4 mm in size, in the third layer of the stomach wall (Fig. 1B). The hypoechoic fourth layer was intact and could be observed below the tumor (Fig. 1C).Endoscopic submucosal dissection and tunneling procedures using novel image-enhanced technique
Recent innovations in image-enhanced endoscopy allow early detection and management of GI lesions. In this study, we aim to analyze the utility of texture and color enhancement imaging (TXI) and red dichromatic imaging (RDI) during endoscopic submucosal dissection (ESD) and submucosal tunneling procedures.Combination of rubber band traction and partial injection for effective under-gel endoscopic mucosal resection of an ileocecal valve lesion
Neoplasms on the ileocecal valve (ICV) extending into the terminal ileum complicate EMR and endoscopic submucosal dissection (ESD), resulting in lower complete-resection rates; this leads to tumor recurrence.1,2 ESD for ICV neoplasms, although feasible and effective, is time-consuming and not yet established as a standard procedure.2Endoscopic submucosal dissection for a laterally spreading ampullary carcinoma
Endoscopic papillectomy (EP) is not standard of care for early ampullary carcinoma but may be considered in select situations owing to its minimal invasiveness compared with pancreaticoduodenectomy and the low incidence of lymph node metastasis.1,2 However, the curative resection rate of EP with negative margins was limited to approximately 87% of patients with neoplastic ampullary lesions.3The utility of image-enhanced endoscopy and Lugol’s for the assessment of esophageal squamous carcinoma
Esophageal squamous cell carcinoma (ESCC) is the most commonly diagnosed esophageal cancer.1 Previously, diagnoses in the late stages of disease led to a poor prognosis and limited treatment. However, advancements in optical diagnosis and resection techniques have allowed for improved detection, characterization, and therapy. We present a case that highlights the utility of image-enhanced endoscopy and Lugol’s in the assessment of ESCC (Video 1, available online at www.giejournal.org ).Balloon tamponade for control of myotomy bleeding during peroral endoscopic myotomy
Peroral endoscopic myotomy has revolutionized the management of achalasia. Although capnoperitoneum or capnomediastinum are not uncommonly seen in the immediate postprocedure setting, severe adverse events such as perforation and bleeding requiring cessation of the procedure are rare. Individuals with a sigmoid-shaped esophagus are known to be at increased risk for adverse events. Minor bleeding is relatively common during submucosal tunneling and is treated easily using coagulation from the dissecting needle itself, cap tamponade, or coagulation forceps for larger vessels.Endoscopic through-the-scope suturing
There is growing interest in closure of larger mucosal defects, given the increasing use of endoscopic resection for early GI neoplasia and the advent of submucosal endoscopy, including peroral endoscopic myotomy. Existing closure methods include through-the-scope clips, over-the-scope clips, and over-the-scope suturing. Although over-the-scope clips and over-the-scope suturing allow closure of large defects, both require endoscope removal for device application and may have difficulty in treating lesions in the proximal colon or the small intestine.Peroral endoscopic myotomy for a residual Zenker’s diverticulum following endoscopic myotomy
Symptomatic Zenker’s diverticulum can be associated with significant morbidity. Zenker’s diverticulum can persist after flexible endoscopic myotomy. Several endoscopic and surgical techniques can be considered, but it is unclear which interventions are feasible and appropriate for residual Zenker’s diverticulum.Endoscopic submucosal dissection by using a new traction device
Several devices and techniques have been described to assist endoscopic submucosal dissection (ESD), but all have their limitations. Most enable only traction,1 some are invasive2 or complex,3 and others demand several steps.4 We describe the use of a new traction wire device (ProdiGi Traction Wire, Medtronic, Minneapolis, Minn, USA) that is easy to deploy and enables easier access to the submucosa during ESD.
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