ASGE JGES Primer ESD (On-Demand) | September 2022-Abe

Abe_Handout Colorectal ESD

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This document provides an overview of the procedure set up and techniques for performing colorectal endoscopic submucosal dissection (ESD). The author, Dr. Seiichiro Abe, discloses personal fees and research funding from various companies. The need for colorectal ESD is discussed, highlighting the limitations of piecemeal EMR and the risk of local recurrence and invasive recurrence with malignancy. The outlines of the procedure include set up, basic technique, traction technique, and the anatomy of the colorectum. <br /><br />Preoperative care recommendations for ESD include adequate bowel prep, the use of spasmolytic agents, and no specific care for sedation and antithrombotic drugs. Scope selection involves using high-definition slim pediatric colonoscopes or therapeutic gastroscopes depending on the location. <br /><br />Scope insertion is emphasized, with a technique called axis keeping shortening recommended to keep the colon straight. Various devices for colorectal ESD are mentioned, including needle type knives, CO2 insufflators, and different hood types. <br /><br />Optimal patient positioning is discussed, involving positioning the lesion opposite to the gravity-dependent side and changing positions as necessary during ESD. The techniques for mucosal flap creation, submucosal dissection, and mucosal incision are described. Intraoperative bleeding management is also addressed, including contact coagulation and the use of suction. <br /><br />The manipulation of the endoscope is detailed, including movements such as up, down, left, right, pull, push, and turn. Traction devices, such as the SO Clip and pocket creation method, are mentioned for use in the proximal colon. <br /><br />The take-home messages for successful colorectal ESD include optimal scope and device selection, practice for improved outcomes, meticulous device control, and satisfactory traction to mitigate the risk of perforation.

Keywords

colorectal endoscopic submucosal dissection

procedure set up

limitations of piecemeal EMR

local recurrence

preoperative care recommendations

scope selection

devices for colorectal ESD

mucosal flap creation

intraoperative bleeding management

successful colorectal ESD