ASGE JGES Primer ESD | September 2022-Yuto Shimamura

Yuto Shimamura_ESD Basic Techniques

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This document provides an overview of basic techniques for performing endoscopic submucosal dissection (ESD). ESD is a procedure used for the removal of early-stage gastrointestinal tumors. The document discusses various aspects of ESD, including preparation, distal attachments, electrosurgical knives, injection techniques, mucosal incision, trimming, and submucosal dissection.<br /><br />Preparation for ESD involves using distal attachments, such as the super soft hood, to adjust to narrow spaces and maintain a clear field of view. The document also lists the different types of electrosurgical knives that can be used in ESD procedures.<br /><br />Injection techniques are critical for creating a submucosal cushion to elevate the lesion and provide better visualization. Different solutions with varying durations and advantages are discussed.<br /><br />Mucosal incision and trimming techniques are explained, emphasizing the importance of achieving deep submucosal dissection while avoiding bleeding and charring. The document also suggests the use of water pressure to open up the submucosal layer and improve visualization.<br /><br />Traction techniques, both external and internal, are highlighted as effective methods for achieving a good view of the operative field and improving dissection efficiency. The document describes the clip with line method and the multi-loop traction device as examples of traction techniques.<br /><br />Tips for beginners in ESD are provided, including the importance of slow but steady progression, avoiding rushing or working too far from the lesion, and practicing proper scope maneuverability.<br /><br />Overall, the document aims to provide a comprehensive understanding of ESD techniques and strategies to ensure safe and effective procedures.

Keywords

endoscopic submucosal dissection

ESD

gastrointestinal tumors

distal attachments

electrosurgical knives

injection techniques

mucosal incision

trimming

submucosal dissection

traction techniques