ASGE-JGES Endoscopic Submucosal Dissection ESD (On-demand) | October 2025-Principles of Flap ESD Technique

Video Transcription

Video Summary

Dr. Mohamed Otsman presents a comprehensive overview of conventional Endoscopic Submucosal Dissection (ESD), emphasizing the crucial first step: creating a mucosal flap to access the submucosa. He differentiates between ESD technique (flap formation) and strategy (approach to lesion), explaining standard circumferential incision, tunneling, and pocket techniques adapted for different gastrointestinal locations. Key procedural steps include marking the lesion margin sufficiently outside to ensure complete resection, injecting lifting solution outside the marks for optimal elevation, performing careful mucosal incision, and dissecting to form the initial flap while avoiding deep muscle injury or bleeding. He highlights common pitfalls such as perforation, bleeding, and fatigue, advising slow, uniform injections and ergonomic practice. Traction methods, including simple snares or dynamic devices, assist visualization and dissection once the flap is created. The talk stresses patience, safety, and methodological precision in flap creation as essential for effective and safe ESD procedures.

Asset Subtitle

Mohamed Othman

Keywords

Endoscopic Submucosal Dissection

mucosal flap creation

circumferential incision

traction methods

ESD procedural safety