Endoscopic Submucosal Dissection (ESD) (On-Demandl) | December 2024-Lab Demo 6

Video Transcription

Video Summary

In this video, Dr. Yamamoto demonstrates the tunneling method for esophageal endoscopic submucosal dissection (ESD). Initially, Dr. Yamamoto places marks on the lesion and considers different coagulation techniques, opting for forced coag as a last resort. The strategy involves making distal and proximal injections, followed by incisions, and creating a submucosal tunnel for stability and traction without additional devices. <br /><br />For smaller lesions, a C-shaped incision suffices, but larger lesions may benefit from the tunneling technique, sometimes combined with dental floss traction or a multi-traction device. Dr. Yamamoto prefers the TTJ knife, especially due to its directional cutting abilities, although it requires expert endoscopic control. He demonstrates care during flap creation, emphasizing the importance of cutting from the inside out to avoid muscle injury.<br /><br />Throughout the procedure, adjustments are made, including switching to dry or endocut waveform settings. Trainees typically practice gastric ESD before progressing to techniques like the poem. Dr. Yamamoto highlights the challenges of working with porcine models due to differences in tissue thickness compared to human esophagi.

Keywords

esophageal endoscopic submucosal dissection

tunneling method

Dr. Yamamoto

TTJ knife

coagulation techniques

submucosal tunnel

flap creation

porcine models