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

Aihara_ESD

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ESD (Endoscopic Submucosal Dissection) is a technique used for the resection of superficial cancers in the gastrointestinal tract. This presentation by Dr. Hiroyuki Aihara discusses the fundamentals of ESD and appropriate patient selection for the procedure.<br /><br />ESD involves several steps, including marking, injection, mucosal incision, submucosal dissection, and hemostasis. It is indicated for lesions with minimal risk of lymph node metastasis, such as low-grade dysplasia, high-grade dysplasia, intramucosal carcinoma, and superficial submucosal carcinoma.<br /><br />The presentation highlights the history of ESD, including the development of various instruments like the Yahagi Flex knife, Oyama Hook knife, Yamamoto ST hood, Inoue Triangle knife, Toyonaga Flush Knife, and others. FDA approval for ESD in the US was obtained, and several ESD courses were organized.<br /><br />ESD offers several advantages over conventional EMR (Endoscopic Mucosal Resection), including en-bloc resection regardless of size, accurate histopathological analysis, and curative resection for superficial cancers. EMR, on the other hand, often results in piecemeal resection and carries a higher risk of recurrence.<br /><br />The presentation emphasizes the importance of curative resection with negative margins for successful cancer treatment. ESD allows for accurate T staging, which helps determine the extent of cancer invasion and the need for further treatment.<br /><br />The selection of patients for ESD is based on various factors, including tumor size, differentiation, invasion depth, tumor budding, and lymphovascular invasion. Curative resection is more likely in cases with no deep invasion, no poorly differentiation, no tumor budding, and no lymphovascular invasion.<br /><br />The presentation concludes by summarizing the advantages of ESD over EMR and surgery, including higher en-bloc resection rate, curative treatment for cancer, lower recurrence rate, minimal adverse events, and organ-sparing treatment.<br /><br />In summary, ESD is a valuable technique for the resection of superficial cancers in the gastrointestinal tract. Appropriate patient selection and achieving curative resection are crucial for successful outcomes.

Keywords

Endoscopic Submucosal Dissection

ESD

superficial cancers

gastrointestinal tract

patient selection

curative resection

histopathological analysis

EMR

en-bloc resection

recurrence