Advanced Endoscopy Fellows Program | September 2022-5_A specimen collection technique to ensure that the resected specimen is safely retrieved after duodenal ESD

Video Transcription

A specimen collection technique to ensure that the resected specimen is safely retrieved after duodenal ESD. Backgrounds.  It is important to ensure that the resected specimen is collected for precise pathological examination.  However, there is no report on the collection method for duodenal specimens resected by ESD.  Herein, we present the safe and easy collection method of duodenal specimens resected by ESD. This method can be applied for all duodenal ESD equipment and preparation.  We use large grasping forceps or collection nets. We will show the collection method in the video. Case 1. Collection method using large grasping forceps.  A flat elevated 30 mm region located in the descending portion of duodenum. ESD was performed.  A bundle of 1 mm submucosal fiber is left behind. Although the lesion would be floppy, the submucosal fibers will not allow it to spontaneously break off.  The remaining bundle of fibers is bluntly sheared off with large grasping forceps.  No tissue is left on the dissected ulcer floor. The lesion could be retrieved without any artificial damage. Case 2. Collection method using a collecting net.  A flat elevated 20 mm lesion is located in the descending portion of duodenum. ASD was performed.  A bundle of 1 mm samkozo fiber is left behind.  The remaining bundle of fibers is voluntarily sheared off with a collecting net.  Once the lesion is sheared, the endoscope is withdrawn while holding the specimen within its grasp. No tissue is left on the dissected ulcer floor.  The lesion could be retrieved without any artificial damage.  The key to this method is to leave a thin bundle of 1 mm width of samkozo fibers for the linkage to build in a wall before collecting the lesion.  This technique can ensure collection of the dissected specimen without losing it. Extracted specimens are not damaged, so we can evaluate a precise pathological diagnosis.  This method is safe, easy, and reliable to save the dissected specimen in the ordinal ESD.

Video Summary

This video demonstrates a safe and easy method for collecting duodenal specimens after endoscopic submucosal dissection (ESD). The goal is to ensure the accurate examination of resected specimens. The video showcases two cases: one using large grasping forceps and the other using a collecting net. In both cases, a submucosal fiber bundle is left behind to prevent the specimen from breaking off. The remaining fiber bundle is then sheared off using the corresponding tool. This method allows for the retrieval of the specimen without causing artificial damage. It ensures the preservation of the specimen for precise pathological examination. This technique is applicable to all duodenal ESD equipment and preparations. (No credits mentioned)

Keywords

duodenal specimens

endoscopic submucosal dissection

collecting method

large grasping forceps

collecting net