ASGE JGES Advanced ESD | September 2022-Lab Hands on Virtual Demonstration Part 3

Video Transcription

Video Summary

The video is a demonstration of a technique called the water pressure method for endoscopic submucosal dissection (ESD). The speaker explains that the water pressure method utilizes the active pressure of normal saline to open the submucosal space during ESD procedures. They demonstrate the technique using a pig stomach model and work together with Valeria from Mayo Scottsdale and Dr. Yamamoto.<br /><br />Before starting the procedure, the speaker emphasizes the importance of thoroughly washing the lumen until it is clean. They then use a 2.0 millimeter dual knife J to make a marking dot and check the cleanliness of the knife tip. They explain that the dual knife J is a multi-function device that can place the marking dot, make mucosal incisions, perform submucosal dissection, and inject additional fluid cushion.<br /><br />The speaker then explains the steps for injecting normal saline into the submucosal space, demonstrating the technique and explaining that viscous agents are not necessary for the water pressure method. They emphasize the importance of checking the lifting sign during injection.<br /><br />They move on to demonstrate the technique for making a circumferential mucosal incision using the dual knife J. They explain that underwater conditions can be used to improve visualization, and they use the end cut setting for cutting while avoiding the formation of air bubbles. They also explain that the water pressure method can be used for ESD in various regions and instances, including in regions with fibrosis or angulation and in non-gravity dependent regions.<br /><br />During the submucosal dissection, the speaker demonstrates how to open the submucosal layer by brushing normal saline and utilizing the water pressure. They explain the importance of staying on the surface and avoiding pushing too deep.<br /><br />The speaker answers various questions throughout the video, including questions about preventing air bubbles, the use of clip traction, and the settings for end cut during dissection.<br /><br />The video concludes with the speaker thanking the viewers and inviting any further questions.

Keywords

water pressure method

endoscopic submucosal dissection

normal saline

dual knife J

mucosal incision

viscous agents

lifting sign