ASGE-JGES Endoscopic Submucosal Dissection ESD (On-demand) | October 2025-Principles of the Pocket-Tunneling & Retraction Techniques

Principles of the Pocket-Tunneling & Retraction Techniques - Yang

Video Transcription

Video Summary

Dr. Dennis Yang from the Center of Interventional Endoscopy discusses advanced techniques for Endoscopic Submucosal Dissection (ESD), emphasizing its technical challenges and complexity akin to minimally invasive surgery but performed endoscopically with one hand. He highlights the critical role of traction—comparing it to a fork holding tissue in place—and notes gravity as the simplest, cost-effective traction method, which aids visualization and reduces bleeding during resection. Dr. Yang details pocket tunneling and mucosal tunneling techniques that use the lesion itself for stability and working space, improving precision and fluid retention. Internal traction methods, such as clip-and-rubber band or clip-and-string systems, provide adjustable tissue tension, enhancing dissection. Dynamic devices like Fuji’s Track Motion allow real-time tissue manipulation. He also advocates underwater ESD for better visualization and tissue floatation but cautions about electrosurgical adjustments underwater. Ultimately, Dr. Yang stresses no single technique suits all cases; combining methods based on lesion characteristics and strategic planning boosts success in ESD procedures.

Keywords

Endoscopic Submucosal Dissection

traction techniques

pocket tunneling

internal traction devices

underwater ESD