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

Hwang-ASGE ESD Energy

Pdf Summary

This document by Dr. Joo Ha Hwang outlines the principles of electrosurgery in Endoscopic Submucosal Dissection (ESD), focusing on the use and settings of electrosurgical generators and knives. Most ESD knives are monopolar with varying tip shapes, lengths, and insulation, some also enabling submucosal injection.<br /><br />Key electrosurgical settings are tailored for different procedural steps: mucosal marking, incision, submucosal dissection, and hemostasis. Mucosal marking uses low-power coagulation currents (preferably Soft Coag over high-power forced or spray coag to avoid deep tissue damage or superficial marks falling off). Incision employs cutting currents like EndoCut or Dry Cut, with adjustable parameters—effect (coagulation level), duration (cut pulse length), and interval (time between pulses)—to optimize cutting sharpness and coagulation balance.<br /><br />Submucosal dissection uses a mix of cut and coag modes (except Soft Coag), influenced by local tissue factors such as vascularity and fibrosis. Techniques include pre-coagulating vessels to prevent bleeding and using high-current density settings in fibrotic areas. Hemostasis depends on bleeding severity and vessel size; Soft Coag is recommended with coagulation graspers, while other settings require low power and careful blade positioning.<br /><br />Generator mode waveforms range from unmodulated pure cut currents to modulated coagulation currents, affecting tissue interaction intensity. Modulation reduces cutting effect but increases coagulation. The EndoCut mode is explained in detail with parameters influencing cutting rhythm and coagulation intensity.<br /><br />The key takeaway is the importance of understanding one's electrosurgical generator and adjusting settings based on the knife, tissue characteristics, and procedural goals for effective, safe ESD. Proper use of settings helps optimize mucosal incision, submucosal dissection, fibrosis management, and hemostasis, ultimately improving procedural outcomes.

Keywords

Electrosurgery

Endoscopic Submucosal Dissection

ESD knives

Monopolar knives

Electrosurgical generator settings

Mucosal marking

Incision currents

Submucosal dissection

Hemostasis techniques

EndoCut mode