ASGE-JGES Endoscopic Submucosal Dissection ESD (Live and Virtual)

Video Transcription

Video Summary

This live demonstration features Dr. Fei Inoki performing gastric ESD using the IT knife and dual J knife. Key points include the importance of using two knives—one for marking and initial incision, the other for dissection—and adjusting generator settings appropriately for live versus ex-vivo tissue due to differences in water content. Dr. Inoki emphasizes injecting the distal side of the lesion to elevate mucosa before making the mucosal incision, and highlights the importance of deflating the stomach to thicken and soften tissues for easier dissection. The IT knife technique involves careful edge-to-edge cutting under the lesion, avoiding excessive coagulation that may char tissue and obscure margins. Vessel coagulation during ESD is routine due to bleeding risks, though closure of defects is not typically performed in Japan, with shorter hospital stays post-procedure. The discussion covers differences in practices between Japan and the U.S., including prophylactic treatments and stricture prevention in esophageal ESD. Overall, the session provides detailed technique tips and practical clinical insights for gastric ESD.

Keywords

gastric ESD

IT knife

dual J knife

mucosal incision

vessel coagulation

Japan vs US practices