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Create a Free AccountProcedures - Endoscopic submucosal dissection (ESD)
Novel articulating through-the-scope traction device
Endoscopic submucosal dissection (ESD) has become a standard approach for treating superficial GI neoplasia, but its adoption remains limited because of its steep learning curve and extensive resource utilization when performed by endoscopists in the earlier stages of the ESD learning curve.1,2 Furthermore, although traction strategy has emerged to improve clinical outcomes and increase procedural efficiency, current techniques and devices own inherent limitations such as technical complexity, lack of adjustability, or demanding preparation.Endoscopic submucosal dissection with ductotomy for the resection of a gastric duplication cyst with a communicating duct
A 40-year-old otherwise healthy woman with persistent upper abdominal pain was found to have a 3-cm subepithelial lesion in the prepyloric area and was referred to our center (Fig. 1). EUS showed an anechoic cyst in the submucosa with well-defined outer sonographic borders suggesting a gastric duplication cyst (GDC) (Fig. 2). The cyst was completely aspirated and yielded 40 mL of serous fluid with negative cytology for malignancy. The patient’s symptoms resolved for 3 weeks but then recurred. A CT scan showed the cystic lesion with diameters of 3.2 × 1.2 × 1.1 cm.Hybrid endoscopic submucosal dissection with novel helix tacking system for defect closure
A 60-year-old man with a history of adenomatous colon polyps presented to our institution for surveillance colonoscopy. Initial colonoscopy revealed a carpet-like, 40-mm, laterally spreading tumor granular type lesion in the sigmoid colon on high-definition white-light endoscopy (Fig. 1A). Further examination of the lesion via image-enhanced endoscopy with blue light imaging and chromoendoscopy with indigo carmine revealed a Japan NBI Expert Team Type 2A lesion and Kudo type IV pit pattern, respectively (Fig. 1B and C).Emerging therapies in translational endoscopy: new frontiers in endoscopic submucosal dissection
The field of therapeutic endoscopy is evolving with a variety of new endoscopic surgical procedures. One such procedure, endoscopic submucosal dissection (ESD), has proven efficacy, yielding high margin-negative (R0) resection rates with low rates of adverse events and recurrence.1 However, the technical complexity, long procedure duration, and steep learning curve associated with ESD have led to relatively slow adoption. Although there has been an increased trend in devices and tools that may assist with ESD, there remains a paucity of advances in endoscopic technology, which are much needed given these known barriers.Endoscopic submucosal tunneling dissection: use of a novel bipolar radiofrequency and microwave-powered device for colorectal endoscopic submucosal dissection
A 57-year-old man with no significant medical history was referred for colonoscopy after positive multitarget stool DNA testing (FIT-DNA testing) as part of routine screening for colorectal cancer. The patient was asymptomatic with no family history of colorectal cancer. An initial colonoscopy revealed a large, 60-mm, laterally spreading tumor granular-type lesion in the rectum, approximately 3 cm from the anal verge (Fig. 1A). Examination of the lesion via image-enhanced endoscopy with narrow-band imaging revealed a type 2 noninvasive pattern per the narrow-band imaging international colorectal endoscopic classification (Fig. 1B).A novel clip-band traction device to facilitate colorectal endoscopic submucosal dissection and defect closure
Endoscopic submucosal dissection (ESD) allows for en bloc resection of large superficial lesions throughout the GI tract.1,2 Adequate visualization of the submucosal dissection plane is critically important for both safety and efficacy in ESD. In traditional surgery, an assistant provides effective countertraction. However, this is not feasible with endoscopic resection, wherein countertraction is naturally absent, aside from the effects of gravity acting on the partially resected lesion.The suture pulley countertraction method for challenging rectal endoscopic submucosal dissection
Densely fibrotic lesions pose special challenges in colorectal endoscopic submucosal dissection (ESD). Submucosal fibrosis can be encountered in lesions with prominent tattoos and in the resection of prior polypectomy scars.1 By obscuring the submucosal dissection plane, dense fibrosis not only raises the technical difficulty and procedure time of ESD but may increase the risk of adverse events.Making the transition from endoscopic submucosal dissection fellowship to independent practice: successful ESD of a large near-circumferential rectal lesion
Widespread adoption of endoscopic submucosal dissection (ESD) in the United States has been challenging, partly because of the limited availability of training opportunities.1 Recently, a junior faculty member based in the United States completed a novel 1-year ESD training program within a traditional American Society for Gastrointestinal Endoscopy fourth-year advanced endoscopy fellowship.2 During the course of the training program, the trainee had assisted with or observed 19 cases, partially performed 18 cases, and fully or mainly performed 26 cases, in which the mean lesion diameter was 44.5 mm and in which 79.2% of lesions were colorectal.Robotic-assisted surgical endoscopy: a new era for endoluminal therapies
Minimally invasive endoscopic procedures are associated with lower adverse events and shorter hospital stays compared with conventional open surgery.1,2 However, some advanced endoscopic procedures, including endoscopic submucosal dissection (ESD), natural orifice transluminal endoscopic surgery (NOTES), and suturing, have typically required specialized training and a certain amount of experience to achieve competency. Therefore, these procedures are not widely performed in nonspecialized centers.Subpyloric tunneling endoscopic submucosal dissection: a novel technique for safe and successful removal of a challenging duodenal submucosal lesion
Owing to their anatomic location, submucosal lesions in the proximal duodenal bulb can be challenging to resect by EMR. Here, we present a novel endoscopic submucosal dissection (ESD) technique for successful removal of a duodenal submucosal lesion (Video 1, available online at www.VideoGIE.org ).Endoscopic tunneled stricturotomy in the treatment of stenosis after sleeve gastrectomy
Obesity is a worldwide pandemic, and bariatric surgery is the most effective method used to treat this disease. Laparoscopic sleeve gastrectomy (LSG) is rapidly becoming the most commonly performed bariatric surgery because it is perceived as being the “easier technique.” Despite clinical efficacy, adverse events have gradually increased because of its broad adoption.1-3Duodenal endoscopic submucosal dissection and sutured defect closure across a lumen-apposing metal stent
Patients with gastric bypass anatomy face unique challenges and limited options with respect to endoscopy in the bypassed portion of the stomach and duodenum.1 Here we introduce a novel technique for EUS-guided creation of a temporary access tract and demonstrate various therapeutic interventions that can be safely and effectively performed across the access tract in the bypassed duodenum (Video 1, available online at www.VideoGIE.org ).Successful removal of duodenal submucosal tumors with endoscopic submucosal dissection
Endoscopic submucosal dissection (ESD) in the duodenal bulb is technically challenging because of the thin wall and perpendicular angulation of the duodenum. However, ESD allows for the en bloc resection of both mucosal and submucosal lesions, which may theoretically allow for lower recurrence rates. We present 2 cases of ESD for resection of submucosal neoplasms in the duodenal bulb, and we highlight techniques and strategies for successful resection (Video 1, available online at www.VideoGIE.org ).Countertraction in endoscopic submucosal dissection
Endoscopic submucosal dissection (ESD) allows en bloc resection of GI tumors regardless of lesion size or location. Extensive biopsies, partial endoscopic removal, and tattooing of these lesions are routinely performed in the United States, and these maneuvers lead to submucosal fibrosis, making subsequent ESD technically challenging. Countertraction is imperative in such cases. Two representative technically challenging ESD cases facilitated by countertraction methods are described here (Fig 1; Video 1, available at www.VideoGIE.org ).Successful removal of an esophageal submucosal tumor by the submucosal tunneling endoscopic resection technique
We describe a case of a submucosal esophageal tumor successfully removed by a submucosal tunneling endoscopic resection (STER) technique. Informed consent was obtained from the patient for the publication of his information and imaging.
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